Healthcare Provider Details

I. General information

NPI: 1518884600
Provider Name (Legal Business Name): MOHAMED TARAWALLIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MARLYS DR W
WEST FARGO ND
58078-2963
US

IV. Provider business mailing address

1133 MARLYS DR W
WEST FARGO ND
58078-2963
US

V. Phone/Fax

Practice location:
  • Phone: 701-306-9811
  • Fax:
Mailing address:
  • Phone: 701-306-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number200979
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: