Individual
FATIMA SUFI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SYSTEM ADMINISTRATOR
Contact information
Practice address
1107 HAZELTINE BLVD STE 484, CHASKA, MN 55318-1065
(612) 446-5480
Mailing address
1107 HAZELTINE BLVD STE 484, CHASKA, MN 55318-1065
(612) 446-5480
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
411159
MN
122300000X
Dentist
411159
MN
251J00000X
Nursing Care Agency
411159
MN
253J00000X
Foster Care Agency
411159
MN
261Q00000X
Clinic/Center
411159
MN
261QR0400X
Rehabilitation Clinic/Center
Primary
411159
MN
261QR0800X
Recovery Care Clinic/Center
411159
MN
310400000X
Assisted Living Facility
411159
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411159
MINNESOTA DEPARTMENT OF HEALTH
MN
Enumeration date
03/06/2023
Last updated
03/06/2023
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