Healthcare Provider Details

I. General information

NPI: 1801487798
Provider Name (Legal Business Name): AYAN AHMED HASSAN DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date: 05/12/2023
Reactivation Date: 06/25/2024

III. Provider practice location address

270 MAIN ST N STE 300
STILLWATER MN
55082-6788
US

IV. Provider business mailing address

270 MAIN ST N STE 300
STILLWATER MN
55082-6788
US

V. Phone/Fax

Practice location:
  • Phone: 651-342-1039
  • Fax: 651-342-1428
Mailing address:
  • Phone: 651-342-1039
  • Fax: 651-342-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13993
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: