Provider Demographics
NPI:1083403323
Name:AWIL, AYAN M
Entity type:Individual
Prefix:
First Name:AYAN
Middle Name:M
Last Name:AWIL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 PENN AVE S # D138
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3666
Mailing Address - Country:US
Mailing Address - Phone:952-212-0391
Mailing Address - Fax:
Practice Address - Street 1:7610 PENN AVE S # D138
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423-3666
Practice Address - Country:US
Practice Address - Phone:952-212-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10837800376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide