Provider Demographics
NPI:1467289777
Name:HASSAN, FATUMA DAGANE
Entity type:Individual
Prefix:
First Name:FATUMA
Middle Name:DAGANE
Last Name:HASSAN
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 1:1505 SOUTHCROSS DR W STE 201
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7015
Mailing Address - Country:US
Mailing Address - Phone:612-298-1267
Mailing Address - Fax:612-234-6566
Practice Address - Street 1:14041 BURNHAVEN DR STE 150
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4442
Practice Address - Country:US
Practice Address - Phone:612-298-1267
Practice Address - Fax:612-234-6566
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician