Provider Demographics
NPI:1811547029
Name:ABDI MOHAMUD, AMAAL (RN)
Entity type:Individual
Prefix:MRS
First Name:AMAAL
Middle Name:
Last Name:ABDI MOHAMUD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMAAL
Other - Middle Name:
Other - Last Name:ABDI MOHAMUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:11420 42ND PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1421 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-5200
Practice Address - Country:US
Practice Address - Phone:612-886-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2314749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2314749OtherRN