Healthcare Provider Details

I. General information

NPI: 1306474903
Provider Name (Legal Business Name): HODAN ALI WARSAME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 OLD HIGHWAY 8 STE 101F
SAINT ANTHONY MN
55418-2500
US

IV. Provider business mailing address

3055 OLD HIGHWAY 8 STE 101F
SAINT ANTHONY MN
55418-2500
US

V. Phone/Fax

Practice location:
  • Phone: 612-259-7715
  • Fax: 612-259-7889
Mailing address:
  • Phone: 612-259-7718
  • Fax: 612-259-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: