Healthcare Provider Details

I. General information

NPI: 1538980370
Provider Name (Legal Business Name): NISREEN ABDELMUTI ABUHADID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W 64TH ST
MINNEAPOLIS MN
55423-1001
US

IV. Provider business mailing address

1160 SUNCREST DR APT 340
SAINT CLOUD MN
56301-0016
US

V. Phone/Fax

Practice location:
  • Phone: 612-861-1688
  • Fax:
Mailing address:
  • Phone: 612-567-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26248
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: