Provider Demographics
NPI:1114477858
Name:ABDI, NIMO SALEBAN
Entity Type:Individual
Prefix:
First Name:NIMO
Middle Name:SALEBAN
Last Name:ABDI
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 1:10067 GRISTMILL RDG
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4761
Mailing Address - Country:US
Mailing Address - Phone:612-226-2747
Mailing Address - Fax:612-465-4884
Practice Address - Street 1:10067 GRISTMILL RDG
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-4761
Practice Address - Country:US
Practice Address - Phone:612-226-2747
Practice Address - Fax:612-465-4884
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily