Healthcare Provider Details

I. General information

NPI: 1336924836
Provider Name (Legal Business Name): ABDULLAHI HIRSI AHMED AGPCNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST BLDG 43100
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

3600 30TH ST RM 3100
DES MOINES IA
50310-5753
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax:
Mailing address:
  • Phone: 207-312-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberH176825
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR45699
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: