Provider Demographics
NPI:1649009044
Name:ALI, AYAN AHMED
Entity type:Individual
Prefix:
First Name:AYAN
Middle Name:AHMED
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W 80 1/2 ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-5107
Mailing Address - Country:US
Mailing Address - Phone:612-986-9355
Mailing Address - Fax:
Practice Address - Street 1:1901 W 80 1/2 ST UNIT 203
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-5107
Practice Address - Country:US
Practice Address - Phone:612-986-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN416443163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty