Provider Demographics
NPI:1679053284
Name:ABDIKADIR, AMINAH SHANELL (LPN)
Entity Type:Individual
Prefix:
First Name:AMINAH
Middle Name:SHANELL
Last Name:ABDIKADIR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6682 N 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6035
Mailing Address - Country:US
Mailing Address - Phone:414-303-8329
Mailing Address - Fax:
Practice Address - Street 1:6682 N 51ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-6035
Practice Address - Country:US
Practice Address - Phone:414-303-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty