=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861365298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARDULLAH HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7630 145TH ST W STE 16
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55124-7553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-245-8475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7630 145TH ST W STE 16
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55124-7553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-245-8475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | FARDOWSA OSMAN
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 612-245-8475
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------