Provider Demographics
NPI:1427651801
Name:ALLEN-FAHNBULLEH, NIKET NNEKA
Entity type:Individual
Prefix:
First Name:NIKET
Middle Name:NNEKA
Last Name:ALLEN-FAHNBULLEH
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 1:3034 BOONE AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2419
Mailing Address - Country:US
Mailing Address - Phone:612-701-3202
Mailing Address - Fax:
Practice Address - Street 1:3034 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2419
Practice Address - Country:US
Practice Address - Phone:612-701-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25162104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker