=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316476179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMAL SALAH ABDALLE RN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2017
-----------------------------------------------------
Last Update Date | 07/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3809 42ND AVE S STE 100
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55406-3503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-405-3554
-----------------------------------------------------
Fax | 612-400-1100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9114 TYNE LN
-----------------------------------------------------
City | INVER GROVE HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55077-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-347-5334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 14275
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R-217656-3
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------