Healthcare Provider Details

I. General information

NPI: 1427952316
Provider Name (Legal Business Name): FATUMO MOHAMED ABDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 CLIFF RD E STE 200
BURNSVILLE MN
55337-3351
US

IV. Provider business mailing address

2809 CLIFF RD E STE 200
BURNSVILLE MN
55337-3351
US

V. Phone/Fax

Practice location:
  • Phone: 612-978-2108
  • Fax:
Mailing address:
  • Phone: 612-978-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14898
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: