Healthcare Provider Details

I. General information

NPI: 1316476179
Provider Name (Legal Business Name): AMAL SALAH ABDALLE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 42ND AVE S STE 100
MINNEAPOLIS MN
55406-3503
US

IV. Provider business mailing address

9114 TYNE LN
INVER GROVE HEIGHTS MN
55077-4438
US

V. Phone/Fax

Practice location:
  • Phone: 612-405-3554
  • Fax: 612-400-1100
Mailing address:
  • Phone: 651-347-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14275
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-217656-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: