Healthcare Provider Details

I. General information

NPI: 1912785999
Provider Name (Legal Business Name): IKARAM M. HUSSIEN DNP, APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 4TH ST SE
ROCHESTER MN
55904-4717
US

IV. Provider business mailing address

1650 4TH ST SE
ROCHESTER MN
55904-4717
US

V. Phone/Fax

Practice location:
  • Phone: 509-529-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number2475590
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number556
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: