Provider Demographics
NPI:1700294667
Name:HUSSEIN, MIYADA ZIAD (RN)
Entity Type:Individual
Prefix:
First Name:MIYADA
Middle Name:ZIAD
Last Name:HUSSEIN
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 1:1300 GODWARD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1741
Mailing Address - Country:US
Mailing Address - Phone:612-353-4669
Mailing Address - Fax:612-354-2403
Practice Address - Street 1:1300 GODWARD ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1741
Practice Address - Country:US
Practice Address - Phone:612-353-4669
Practice Address - Fax:612-354-2403
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204451-4163W00000X
MN10262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse