Provider Demographics
NPI:1417509100
Name:ABDULLE, DEKA AHMED (CNM)
Entity Type:Individual
Prefix:
First Name:DEKA
Middle Name:AHMED
Last Name:ABDULLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DEKA
Other - Middle Name:NUR
Other - Last Name:ABDULLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 JACOB LANE
Practice Address - Street 2:MAIL STOP 39300A
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:763-587-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-161805-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife