Provider Demographics
NPI:1477181709
Name:HASSAN, NIMAN
Entity Type:Individual
Prefix:
First Name:NIMAN
Middle Name:
Last Name:HASSAN
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 1:5275 EDINA INDUSTRIAL BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2915
Mailing Address - Country:US
Mailing Address - Phone:952-288-9115
Mailing Address - Fax:612-347-8717
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2915
Practice Address - Country:US
Practice Address - Phone:952-288-9115
Practice Address - Fax:612-347-8717
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician