Provider Demographics
NPI:1255903381
Name:HASSAN, ABDIFITAH ABDISALAM
Entity type:Individual
Prefix:
First Name:ABDIFITAH
Middle Name:ABDISALAM
Last Name:HASSAN
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 1:7201 YORK AVE S APT 219
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4445
Mailing Address - Country:US
Mailing Address - Phone:614-589-0263
Mailing Address - Fax:
Practice Address - Street 1:7201 YORK AVE S APT 219
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4445
Practice Address - Country:US
Practice Address - Phone:614-589-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide