Healthcare Provider Details

I. General information

NPI: 1104746478
Provider Name (Legal Business Name): NASTEHO ABUKAR MADEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 BELSLY BLVD APT 206
MOORHEAD MN
56560-5279
US

IV. Provider business mailing address

1402 BELSLY BLVD APT 206
MOORHEAD MN
56560-5279
US

V. Phone/Fax

Practice location:
  • Phone: 651-391-3231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: