Provider Demographics
NPI:1568234987
Name:AHMED, ROSE MICKIE (RN, PHN, CRRN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MICKIE
Last Name:AHMED
Suffix:
Gender:F
Credentials:RN, PHN, CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 RHODE ISLAND AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1208
Mailing Address - Country:US
Mailing Address - Phone:763-228-0912
Mailing Address - Fax:
Practice Address - Street 1:10743 RHODE ISLAND AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-1208
Practice Address - Country:US
Practice Address - Phone:763-228-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1916928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse