Provider Demographics
NPI:1316476179
Name:ABDALLE, AMAL SALAH (RN)
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:SALAH
Last Name:ABDALLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 DALE ST N APT 10
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4537
Mailing Address - Country:US
Mailing Address - Phone:651-347-5334
Mailing Address - Fax:
Practice Address - Street 1:2522 CENTRAL AVE NE STE 204
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3726
Practice Address - Country:US
Practice Address - Phone:651-347-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-217656-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse