Healthcare Provider Details

I. General information

NPI: 1588500979
Provider Name (Legal Business Name): EBADO ALI ADAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 W 12TH ST
GRAND ISLAND NE
68803-3715
US

IV. Provider business mailing address

1812 W 12TH ST
GRAND ISLAND NE
68803-3715
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-2036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberK000010957300
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: