Provider Demographics
NPI:1366987620
Name:ISMAIL, SADIO (RN)
Entity type:Individual
Prefix:
First Name:SADIO
Middle Name:
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2355
Mailing Address - Country:US
Mailing Address - Phone:612-688-1800
Mailing Address - Fax:612-259-8674
Practice Address - Street 1:3248 HILLSIDE CT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2355
Practice Address - Country:US
Practice Address - Phone:612-688-1800
Practice Address - Fax:612-259-8674
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR171310-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse