Individual
FADUMO IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3505 8TH ST S STE 4, MOORHEAD, MN 56560-5108
(701) 541-5975
Mailing address
3505 8TH ST S STE 4, MOORHEAD, MN 56560-5108
(701) 541-5975
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R48749
ND
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487283
—
ND
Enumeration date
03/31/2020
Last updated
01/23/2023
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