Provider Demographics
NPI:1730841784
Name:AHMED, ISMAHAN YASIN (ASSISTED LIVING)
Entity type:Individual
Prefix:
First Name:ISMAHAN
Middle Name:YASIN
Last Name:AHMED
Suffix:
Gender:F
Credentials:ASSISTED LIVING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3805
Mailing Address - Country:US
Mailing Address - Phone:612-407-4735
Mailing Address - Fax:
Practice Address - Street 1:2217 11TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3805
Practice Address - Country:US
Practice Address - Phone:612-407-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN841676002OtherASSISTED LIVING