Provider Demographics
NPI:1932575636
Name:JAMA, ABDUAHMAN W (MANAGER)
Entity Type:Individual
Prefix:
First Name:ABDUAHMAN
Middle Name:W
Last Name:JAMA
Suffix:
Gender:M
Credentials:MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 METRO BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2301
Mailing Address - Country:US
Mailing Address - Phone:952-222-5477
Mailing Address - Fax:952-222-5477
Practice Address - Street 1:7400 METRO BLVD STE 150
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2301
Practice Address - Country:US
Practice Address - Phone:529-222-5477
Practice Address - Fax:952-222-5418
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X
MN388010376G00000X, 374U00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN251J00000XOtherHOME HEALTH AGENCY