Healthcare Provider Details

I. General information

NPI: 1710584339
Provider Name (Legal Business Name): FARTUN ABDULLAHI MOHAMED CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 20TH AVE S
MINNEAPOLIS MN
55454-4400
US

IV. Provider business mailing address

425 20TH AVE S
MINNEAPOLIS MN
55454-4400
US

V. Phone/Fax

Practice location:
  • Phone: 612-332-4973
  • Fax:
Mailing address:
  • Phone: 612-332-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number450
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: