Provider Demographics
NPI:1750734380
Name:ABDI, FATUMO
Entity type:Individual
Prefix:
First Name:FATUMO
Middle Name:
Last Name:ABDI
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 1:1671 CENTURY CIR
Mailing Address - Street 2:APT 116
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4203
Mailing Address - Country:US
Mailing Address - Phone:651-315-2227
Mailing Address - Fax:
Practice Address - Street 1:1671 CENTURY CIR
Practice Address - Street 2:APT 116
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4203
Practice Address - Country:US
Practice Address - Phone:651-315-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR211899-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR211899-0OtherREGISTERED NURSE