Provider Demographics
NPI:1346010550
Name:ABDULJABBAR, HAYDER
Entity Type:Individual
Prefix:
First Name:HAYDER
Middle Name:
Last Name:ABDULJABBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 2ND PL NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7594
Mailing Address - Country:US
Mailing Address - Phone:507-316-7007
Mailing Address - Fax:
Practice Address - Street 1:1903 BROADWAY AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7924
Practice Address - Country:US
Practice Address - Phone:507-316-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide