MEDICARE: NIMO OSMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1085372-1-HCBS	MN
2	372600000X	Adult Companion	1085372-1-HCBS	MN
3	385H00000X	Respite Care	1058372-1-HCBS	MN
4	376J00000X	Homemaker	1085372-1-HCBS	MN

General Provider Information

NPI Number	:	1023532892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMO OSMAN

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W STE S336
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2876
Country	:	US
Telephone Number	:	651-757-7981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W STE S336
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2876
Country	:	US
Telephone Number	:	651-757-7981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	07/21/2022

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Directions to “ NIMO OSMAN ” Practice Location

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