MEDICARE: AYOUB NIGATU MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		MN

General Provider Information

NPI Number	:	1043750078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYOUB NIGATU MA

Provider Business Mailing Address
First Line	:	1437 MARSHALL AVE STE 102
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-6345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 MARSHALL AVE STE 102
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-6345
Country	:	US
Telephone Number	:	651-329-6171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	02/23/2017

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Directions to “ AYOUB NIGATU MA” Practice Location

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