Provider Demographics
NPI:1124752084
Name:ISSE, HAMDI MOHAMED
Entity type:Individual
Prefix:
First Name:HAMDI
Middle Name:MOHAMED
Last Name:ISSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 GRAND AVE NE
Mailing Address - Street 2:210
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421
Mailing Address - Country:US
Mailing Address - Phone:651-434-9636
Mailing Address - Fax:
Practice Address - Street 1:4729 GRAND AVE NE APT 210
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3369
Practice Address - Country:US
Practice Address - Phone:651-434-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health