Individual provider · NPI-1

Fowsia S Isse

Health Maintenance Organization · Minneapolis, MN

NPI number1407219645
StatusActive
Last updated in NPPESApr 4, 2016

Details

NPI
1407219645
Entity type
Individual (NPI-1)
Name
Fowsia S Isse
Sex
Female
Sole proprietor
Yes
Enumeration date
Apr 4, 2016
Last updated
Apr 4, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
302R00000X Health Maintenance Organization––Yes
172V00000X Community Health Worker––

Practice location

5519 Lyndale Ave N
Minneapolis, MN 55430-3216

Phone 612-978-7470

Mailing address

324 Jolly Ln Ne
Minneapolis, MN 55421-5049

Phone 612-978-7470

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