Healthcare Provider Details

I. General information

NPI: 1639006554
Provider Name (Legal Business Name): AISHO ABDULLAHI OSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 25TH AVE N STE B1-119
SAINT CLOUD MN
56303-3222
US

IV. Provider business mailing address

918 RANAE LN APT 202
SAINT CLOUD MN
56301-4537
US

V. Phone/Fax

Practice location:
  • Phone: 612-703-5479
  • Fax:
Mailing address:
  • Phone: 320-448-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: