Healthcare Provider Details

I. General information

NPI: 1023927951
Provider Name (Legal Business Name): ASIYA ABDI SALAN MUSSE HAGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 WASHINGTON DR STE 206
EAGAN MN
55122-1354
US

IV. Provider business mailing address

4755 IRONWOOD CIR
MAPLE PLAIN MN
55359-5503
US

V. Phone/Fax

Practice location:
  • Phone: 651-505-9911
  • Fax: 651-505-9912
Mailing address:
  • Phone:
  • 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: