Provider Demographics
NPI:1972204881
Name:ROBLE, ABDI S
Entity Type:Individual
Prefix:
First Name:ABDI
Middle Name:S
Last Name:ROBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 8 1/2 ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6640
Mailing Address - Country:US
Mailing Address - Phone:507-884-2213
Mailing Address - Fax:
Practice Address - Street 1:3604 8 1/2 ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6640
Practice Address - Country:US
Practice Address - Phone:507-884-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide