Provider Demographics
NPI:1720825078
Name:AWGEYDHE, FADUMA A
Entity type:Individual
Prefix:
First Name:FADUMA
Middle Name:A
Last Name:AWGEYDHE
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 1:14125 LOUISIANA AVE S UNIT 7207
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-5667
Mailing Address - Country:US
Mailing Address - Phone:619-941-5655
Mailing Address - Fax:
Practice Address - Street 1:14125 LOUISIANA AVE S UNIT 7207
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-5667
Practice Address - Country:US
Practice Address - Phone:619-941-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health