Provider Demographics
NPI:1053837567
Name:MOHAMED, EBYAN (RN)
Entity Type:Individual
Prefix:
First Name:EBYAN
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 UNIVERSITY AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3316
Mailing Address - Country:US
Mailing Address - Phone:612-378-1040
Mailing Address - Fax:612-378-2850
Practice Address - Street 1:3008 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3316
Practice Address - Country:US
Practice Address - Phone:612-378-1040
Practice Address - Fax:612-378-2850
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR244890-3163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN766822850Medicaid