Healthcare Provider Details

I. General information

NPI: 1801487798
Provider Name (Legal Business Name): AYAN AHMED HASSAN FNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date: 05/12/2023
Reactivation Date: 06/25/2024

III. Provider practice location address

1516 E LAKE ST STE 1512
MINNEAPOLIS MN
55407-1997
US

IV. Provider business mailing address

3760 SILVER LAKE RD NE
MINNEAPOLIS MN
55421-3384
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-4929
  • Fax:
Mailing address:
  • Phone: 612-471-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13993
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: