Provider Demographics
NPI:1427498989
Name:MOHAMED, ANISA
Entity type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:MOHAMED
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 1:902 E 2ND ST STE 109
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6355
Mailing Address - Country:US
Mailing Address - Phone:507-208-7629
Mailing Address - Fax:507-607-8671
Practice Address - Street 1:902 E 2ND ST STE 109
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6355
Practice Address - Country:US
Practice Address - Phone:507-208-7629
Practice Address - Fax:507-607-8671
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10178363LP0808X
MN191429-2374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health