Healthcare Provider Details

I. General information

NPI: 1063109445
Provider Name (Legal Business Name): KIIN HUSSEIN MOHAMED RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W STE 130N
SAINT PAUL MN
55114-1096
US

IV. Provider business mailing address

8200 HUMBOLDT AVE S APT 423
BLOOMINGTON MN
55431-2261
US

V. Phone/Fax

Practice location:
  • Phone: 651-447-3755
  • Fax: 651-444-8923
Mailing address:
  • Phone: 614-558-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0036400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: