Most Relevant Information
Provider Data
| NPI Number: | 1003500695 |
| Provider Name: | IFRAH BASHI LAITOUSSI |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/06/2023 |
| Last Updated: | 09/12/2024 |
Provider Practice Location
1323 23RD ST S STE D
FARGO
ND
581033759
Practice Location Phone/Fax
| Phone: | 7013202102 |
| Fax: |
Provider Mailing Location
1323 23RD ST S STE D
FARGO
ND
581033759
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |