Individual
FADUMO AHMED ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
963 S. ROBERT ST. WEST, ST PAUL, MN 55118-1446
(507) 319-1198
Mailing address
963 S. ROBERT ST. WEST, ST PAUL, MN 55118-1446
(507) 319-1195
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2460612
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
9664
MN
Other
Enumeration date
05/31/2020
Last updated
10/28/2022
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