Provider Demographics
NPI:1386280493
Name:JAFUNEH, ABASS (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ABASS
Middle Name:
Last Name:JAFUNEH
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 WATERSTONE PL APT 308
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-6506
Mailing Address - Country:US
Mailing Address - Phone:952-239-4857
Mailing Address - Fax:
Practice Address - Street 1:9650 WATERSTONE PL APT 308
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-6506
Practice Address - Country:US
Practice Address - Phone:952-239-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7084363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health