Provider Demographics
NPI:1568196418
Name:ALI, RODA HUSSIEN (RN)
Entity Type:Individual
Prefix:MS
First Name:RODA
Middle Name:HUSSIEN
Last Name:ALI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 GARDENA AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5815
Mailing Address - Country:US
Mailing Address - Phone:612-402-5321
Mailing Address - Fax:
Practice Address - Street 1:1469 GARDENA AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5815
Practice Address - Country:US
Practice Address - Phone:612-402-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1750375163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management