Provider Demographics
NPI:1073385951
Name:ABDISAMED, MUNA
Entity Type:Individual
Prefix:
First Name:MUNA
Middle Name:
Last Name:ABDISAMED
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 1:16312 GUNFLINT TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5238
Mailing Address - Country:US
Mailing Address - Phone:952-564-1128
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE 187
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2187
Practice Address - Country:US
Practice Address - Phone:763-321-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician