Provider Demographics
NPI:1023339660
Name:NOOR, SUAD MOHAMED (FIRST YEAR COLLEGE)
Entity type:Individual
Prefix:MISS
First Name:SUAD
Middle Name:MOHAMED
Last Name:NOOR
Suffix:
Gender:F
Credentials:FIRST YEAR COLLEGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 34TH AVE S APT 104
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5101
Mailing Address - Country:US
Mailing Address - Phone:218-443-0844
Mailing Address - Fax:
Practice Address - Street 1:1202 34TH AVE S APT 104
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5101
Practice Address - Country:US
Practice Address - Phone:218-443-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNP586112701519171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1985Medicare UPIN