Individual
FAADUMO OMAR MOHAMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1229 E LAKE ST, MINNEAPOLIS, MN 55407-1620
(612) 822-1203
(612) 871-2161
Mailing address
1229 E LAKE ST, MINNEAPOLIS, MN 55407-1620
(612) 822-1203
(612) 871-2161
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2168607
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311700000X
—
MN
Enumeration date
04/10/2018
Last updated
04/10/2018
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