Individual
FOWSIA S ISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5519 LYNDALE AVE N, MINNEAPOLIS, MN 55430-3216
(612) 978-7470
Mailing address
324 JOLLY LN NE, MINNEAPOLIS, MN 55421-5049
(612) 978-7470
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
ADULT FOSTER CARE
MN
Enumeration date
04/04/2016
Last updated
04/04/2016
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