Healthcare Provider Details

I. General information

NPI: 1205751906
Provider Name (Legal Business Name): ABDULKADIR H NUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W
SAINT PAUL MN
55104-2801
US

IV. Provider business mailing address

2001 17TH ST SE APT 4
ROCHESTER MN
55904-5734
US

V. Phone/Fax

Practice location:
  • Phone: 612-385-4862
  • Fax:
Mailing address:
  • Phone: 612-756-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: