Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 63902 | MN |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 75910 | WI |
NPI | 1396181483 |
---|---|
Provider Name | Fareeda Taher Nazer Hussain |
First Address | Mankato, MN 56001-4752 |
Second Address | Mankato, MN 56001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 20/10/2021 |