Healthcare Provider Details

I. General information

NPI: 1083403323
Provider Name (Legal Business Name): AYAN M AWIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PENN AVE S # D138
MINNEAPOLIS MN
55423-3666
US

IV. Provider business mailing address

7610 PENN AVE S # D138
MINNEAPOLIS MN
55423-3666
US

V. Phone/Fax

Practice location:
  • Phone: 952-212-0391
  • Fax:
Mailing address:
  • Phone: 952-212-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10837800
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: