Provider Demographics
NPI:1588067409
Name:MOGENI, NELLY
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:MOGENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LILAC DR N STE 152
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4536
Mailing Address - Country:US
Mailing Address - Phone:763-516-1222
Mailing Address - Fax:
Practice Address - Street 1:1405 LILAC DR N STE 152
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4536
Practice Address - Country:US
Practice Address - Phone:763-516-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker