Healthcare Provider Details

I. General information

NPI: 1982437901
Provider Name (Legal Business Name): URBAN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BLAISDELL AVE STE 302
MINNEAPOLIS MN
55404-3331
US

IV. Provider business mailing address

870 TRAILS END RD
EAGAN MN
55123-2215
US

V. Phone/Fax

Practice location:
  • Phone: 651-925-9553
  • Fax:
Mailing address:
  • Phone: 651-925-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMAL ABDIFATAH AHMED
Title or Position: OWNER
Credential:
Phone: 651-925-9553