Provider Demographics
NPI:1215824818
Name:MOHAMED, ANIEZ NUR (LICENSED PRAC NURSE)
Entity type:Individual
Prefix:
First Name:ANIEZ
Middle Name:NUR
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:LICENSED PRAC NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 GIRARD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2647
Mailing Address - Country:US
Mailing Address - Phone:612-787-6329
Mailing Address - Fax:
Practice Address - Street 1:9615 GIRARD AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2647
Practice Address - Country:US
Practice Address - Phone:612-787-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN641993164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse