Provider Demographics
NPI:1831961234
Name:AHMED, FADUMA ABDI
Entity type:Individual
Prefix:
First Name:FADUMA
Middle Name:ABDI
Last Name:AHMED
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 1:2705 HERSCHEL ST UNIT B319
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4495
Mailing Address - Country:US
Mailing Address - Phone:612-666-8499
Mailing Address - Fax:
Practice Address - Street 1:4309 MARIGOLD AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1546
Practice Address - Country:US
Practice Address - Phone:612-666-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility