Healthcare Provider Details

I. General information

NPI: 1821821166
Provider Name (Legal Business Name): MR. ABDIGANI ADEN DAGANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 09/06/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 CLEARWATER RD
SAINT CLOUD MN
56301-6190
US

IV. Provider business mailing address

2907 CLEARWATER RD
SAINT CLOUD MN
56301-6190
US

V. Phone/Fax

Practice location:
  • Phone: 320-237-6571
  • Fax:
Mailing address:
  • Phone: 320-237-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: