Healthcare Provider Details

I. General information

NPI: 1962336149
Provider Name (Legal Business Name): ISRA ABDIKARIM MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 LEXINGTON AVE N
ARDEN HILLS MN
55126-6164
US

IV. Provider business mailing address

11294 TYLER ST NE
BLAINE MN
55434-5504
US

V. Phone/Fax

Practice location:
  • Phone: 952-746-5350
  • Fax:
Mailing address:
  • Phone: 612-517-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: