Provider Demographics
NPI:1477078178
Name:ISMAIL, FAISAL AHMED (RN)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:AHMED
Last Name:ISMAIL
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 1:330 4TH ST SW STE 9-B
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3374
Mailing Address - Country:US
Mailing Address - Phone:320-455-2702
Mailing Address - Fax:
Practice Address - Street 1:330 4TH ST SW STE 9-B
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3374
Practice Address - Country:US
Practice Address - Phone:320-455-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2425719163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health