Healthcare Provider Details

I. General information

NPI: 1912465204
Provider Name (Legal Business Name): ANISA MOHAMED ABSHIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 33RD ST SW
WILLMAR MN
56201
US

IV. Provider business mailing address

1301 33RD ST SW
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax:
Mailing address:
  • Phone: 320-231-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: