Provider Demographics
NPI:1487423653
Name:FARAH, MUNA NUR (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MUNA
Middle Name:NUR
Last Name:FARAH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 W 84TH ST STE 370
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1377
Mailing Address - Country:US
Mailing Address - Phone:612-366-9202
Mailing Address - Fax:
Practice Address - Street 1:5270 W 84TH ST STE 370
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1377
Practice Address - Country:US
Practice Address - Phone:952-395-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health