Provider Demographics
NPI:1801665104
Name:AHMEDNOOR, ABDINASIR K
Entity type:Individual
Prefix:
First Name:ABDINASIR
Middle Name:K
Last Name:AHMEDNOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 VALLEY VIEW DR S APT 302
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1562
Mailing Address - Country:US
Mailing Address - Phone:612-987-6223
Mailing Address - Fax:
Practice Address - Street 1:3906 VALLEY VIEW DR S APT 302
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1562
Practice Address - Country:US
Practice Address - Phone:612-987-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health