Individual
GADEEH FAHNBULLEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HOME MAKER
Contact information
Practice address
7900 ZANE AVE N, #104, BROOKLYN PARK, MN 55443-2176
(651) 235-2042
Mailing address
5775 WAYZATA BLVD, SUITE 700, ST LOUIS PARK, MN 55416-1222
(651) 235-2042
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
348032
CLASS A PROFRESSIONAL HOME HEALTH CARE AGENCY
MN
Enumeration date
08/28/2010
Last updated
08/28/2010
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