Provider Demographics
NPI:1689081291
Name:ABDALLA, FARDOWSA MOHAMED (RN)
Entity Type:Individual
Prefix:
First Name:FARDOWSA
Middle Name:MOHAMED
Last Name:ABDALLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3646
Mailing Address - Country:US
Mailing Address - Phone:507-258-5050
Mailing Address - Fax:507-258-5051
Practice Address - Street 1:208 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3646
Practice Address - Country:US
Practice Address - Phone:507-258-5050
Practice Address - Fax:507-258-5051
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2127981163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse