Individual
FADUMO ADAN SALAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(651) 254-7670
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
(651) 254-7670
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7089
MN
Other
Enumeration date
01/28/2020
Last updated
06/08/2020
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