Provider Demographics
NPI:1659192045
Name:OMAR, FATIMA ABDI
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:ABDI
Last Name:OMAR
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 1:497 HUMBOLDT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2866
Mailing Address - Country:US
Mailing Address - Phone:612-423-0012
Mailing Address - Fax:
Practice Address - Street 1:497 HUMBOLDT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2866
Practice Address - Country:US
Practice Address - Phone:612-423-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician