Provider Demographics
NPI:1275197014
Name:AHMED, NASRO ABDULKADIR
Entity Type:Individual
Prefix:
First Name:NASRO
Middle Name:ABDULKADIR
Last Name:AHMED
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 1:2819 HENNEPIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1907
Mailing Address - Country:US
Mailing Address - Phone:952-393-0505
Mailing Address - Fax:
Practice Address - Street 1:2819 HENNEPIN AVE STE C
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1907
Practice Address - Country:US
Practice Address - Phone:952-393-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily