Provider Demographics
NPI:1508512120
Name:MUHUMED, FARTUN AHMED
Entity Type:Individual
Prefix:
First Name:FARTUN
Middle Name:AHMED
Last Name:MUHUMED
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 1:4949 16TH AVE S APT 213
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8930
Mailing Address - Country:US
Mailing Address - Phone:701-781-3101
Mailing Address - Fax:
Practice Address - Street 1:4949 16TH AVE S APT 213
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8930
Practice Address - Country:US
Practice Address - Phone:701-412-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR37570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse