Provider Demographics
NPI:1609555937
Name:MUSE, RIDWAN MOHAMOUD
Entity Type:Individual
Prefix:
First Name:RIDWAN
Middle Name:MOHAMOUD
Last Name:MUSE
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 1:3055 OLD HIGHWAY 8 STE 190
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2595
Mailing Address - Country:US
Mailing Address - Phone:612-345-7659
Mailing Address - Fax:612-605-6300
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 190
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2595
Practice Address - Country:US
Practice Address - Phone:612-345-7659
Practice Address - Fax:612-605-6300
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician