Healthcare Provider Details

I. General information

NPI: 1396652350
Provider Name (Legal Business Name): ABDIRIZAK MOHAMED ALI DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 4TH ST E STE 200
SAINT PAUL MN
55101-1667
US

IV. Provider business mailing address

729 EDGERTON ST
SAINT PAUL MN
55130-4116
US

V. Phone/Fax

Practice location:
  • Phone: 651-361-0035
  • Fax:
Mailing address:
  • Phone: 651-361-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14620
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: