Healthcare Provider Details

I. General information

NPI: 1184921264
Provider Name (Legal Business Name): FAISO ABDULLE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FAISO ABDULLE NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8936 LYNDALE AVE S
BLOOMINGTON MN
55420-2742
US

IV. Provider business mailing address

6300 WEDGWOOD RD N
MAPLE GROVE MN
55311-3647
US

V. Phone/Fax

Practice location:
  • Phone: 952-881-0163
  • Fax:
Mailing address:
  • Phone: 763-551-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7844
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: