Provider Demographics
NPI:1285498816
Name:ANI, MOSOPE
Entity type:Individual
Prefix:
First Name:MOSOPE
Middle Name:
Last Name:ANI
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 1:1571 ROBERT ST S APT 141
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4093
Mailing Address - Country:US
Mailing Address - Phone:763-647-8989
Mailing Address - Fax:
Practice Address - Street 1:1121 JACKSON ST NE STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-3051
Practice Address - Country:US
Practice Address - Phone:612-353-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula