Provider Demographics
NPI:1215664461
Name:ABDULLA, IFTU
Entity type:Individual
Prefix:
First Name:IFTU
Middle Name:
Last Name:ABDULLA
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 1:1600 81ST AVE NE APT 6
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1342
Mailing Address - Country:US
Mailing Address - Phone:763-400-0851
Mailing Address - Fax:
Practice Address - Street 1:1600 81ST AVE NE APT 6
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1342
Practice Address - Country:US
Practice Address - Phone:763-400-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3826970OtherDOT