Provider Demographics
NPI:1518600832
Name:HUSSEIN, AWLE ABDI
Entity Type:Individual
Prefix:
First Name:AWLE
Middle Name:ABDI
Last Name:HUSSEIN
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 1:3739 S PACKARD AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-4325
Mailing Address - Country:US
Mailing Address - Phone:702-888-6442
Mailing Address - Fax:
Practice Address - Street 1:3739 S PACKARD AVE APT 218
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-4325
Practice Address - Country:US
Practice Address - Phone:702-888-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIH2500019746007146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate