Provider Demographics
NPI:1972332112
Name:NUR, ABDULKANI M
Entity type:Individual
Prefix:
First Name:ABDULKANI
Middle Name:M
Last Name:NUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 COUNTY ROAD D CIR E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-6025
Mailing Address - Country:US
Mailing Address - Phone:612-222-0139
Mailing Address - Fax:
Practice Address - Street 1:1255 COUNTY ROAD D CIR E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-6025
Practice Address - Country:US
Practice Address - Phone:612-222-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty