Provider Demographics
NPI:1407546112
Name:MOHAMED, KALTHOUM
Entity Type:Individual
Prefix:
First Name:KALTHOUM
Middle Name:
Last Name:MOHAMED
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 1:161 ROOSEVELT CIR APT 106
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5571
Mailing Address - Country:US
Mailing Address - Phone:612-720-2589
Mailing Address - Fax:
Practice Address - Street 1:622 S FRONT ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2106
Practice Address - Country:US
Practice Address - Phone:507-934-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker