Provider Demographics
NPI:1780401877
Name:ABDIRAHMAN, MARYAN AIDRUAS
Entity type:Individual
Prefix:MISS
First Name:MARYAN
Middle Name:AIDRUAS
Last Name:ABDIRAHMAN
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 1:717 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3140
Mailing Address - Country:US
Mailing Address - Phone:701-412-4355
Mailing Address - Fax:
Practice Address - Street 1:4462 30TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4645
Practice Address - Country:US
Practice Address - Phone:952-217-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant