Provider Demographics
NPI:1073216115
Name:ABDO, LINA FUAD
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:FUAD
Last Name:ABDO
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 1:2501 TAYLOR ST NE # 1A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3731
Mailing Address - Country:US
Mailing Address - Phone:952-200-4338
Mailing Address - Fax:612-324-4106
Practice Address - Street 1:2501 TAYLOR ST NE # 1A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3731
Practice Address - Country:US
Practice Address - Phone:952-200-4338
Practice Address - Fax:612-324-4106
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician