Healthcare Provider Details

I. General information

NPI: 1407424039
Provider Name (Legal Business Name): AMINA HUSSEIN ADEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

3633 CROSSINGS DR
PRESCOTT AZ
86305-7101
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6720
  • Fax:
Mailing address:
  • Phone: 877-634-7333
  • Fax: 866-984-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number258030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: