Provider Demographics
NPI:1023532892
Name:OSMAN, NIMO
Entity type:Individual
Prefix:
First Name:NIMO
Middle Name:
Last Name:OSMAN
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 1:1821 UNIVERSITY AVE W STE S336
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2876
Mailing Address - Country:US
Mailing Address - Phone:651-757-7981
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE S336
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2876
Practice Address - Country:US
Practice Address - Phone:651-757-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1085372-1-HCBS174400000X, 372600000X, 376J00000X
MN1058372-1-HCBS385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care