MEDICARE: HASSAN ABDI MOHAMUD

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	374U00000X	Home Health Aide		MN

General Provider Information

NPI Number	:	1417723594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASSAN ABDI MOHAMUD

Provider Business Mailing Address
First Line	:	430 LITCHFIELD AVE SW STE 8
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-3242
Country	:	US
Telephone Number	:	320-403-0487
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 LITCHFIELD AVE SW STE 8
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-3242
Country	:	US
Telephone Number	:	320-403-0487
Fax Number	:

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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Directions to “ HASSAN ABDI MOHAMUD ” Practice Location

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