Healthcare Provider Details

I. General information

NPI: 1336973023
Provider Name (Legal Business Name): AYAN HASSAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RAYOVAC DR SUITE 002
MADISON WI
53711
US

IV. Provider business mailing address

3031 EWING AVE S
MINNEAPOLIS MN
55416-4255
US

V. Phone/Fax

Practice location:
  • Phone: 612-472-2087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberY006719
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberY006719
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberY006719
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberY006719
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: