MEDICARE: FAISO ABDULLE NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	7844	MN

General Provider Information

NPI Number	:	1184921264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAISO ABDULLE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6300 WEDGWOOD RD N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3647
Country	:	US
Telephone Number	:	763-551-1215
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 WEDGWOOD RD N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3647
Country	:	US
Telephone Number	:	763-551-1215
Fax Number	:

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	04/26/2021

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