Provider Demographics
NPI:1639736150
Name:SIRAT, HASSAN HUSSEIN (RN)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:HUSSEIN
Last Name:SIRAT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 RAYMOND AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1535
Mailing Address - Country:US
Mailing Address - Phone:651-666-0846
Mailing Address - Fax:
Practice Address - Street 1:1068 RAYMOND AVE APT 204
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1535
Practice Address - Country:US
Practice Address - Phone:651-666-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2331230163WH0200X
MN8162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN389359Medicaid
MN2331230Medicaid