Provider Demographics
NPI:1619742590
Name:HUSSEIN, YUSRA DAUD
Entity Type:Individual
Prefix:
First Name:YUSRA
Middle Name:DAUD
Last Name:HUSSEIN
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 1:14701 PORTLAND AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-0003
Mailing Address - Country:US
Mailing Address - Phone:857-415-7648
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER RIDGE CT STE 1
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1613
Practice Address - Country:US
Practice Address - Phone:612-458-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist