Provider Demographics
NPI:1780416297
Name:HASSAN, MUKTAR
Entity type:Individual
Prefix:
First Name:MUKTAR
Middle Name:
Last Name:HASSAN
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 1:4325 10TH AVE S APT 213
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2077
Mailing Address - Country:US
Mailing Address - Phone:207-409-7331
Mailing Address - Fax:
Practice Address - Street 1:4325 10TH AVE S APT 213
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2077
Practice Address - Country:US
Practice Address - Phone:207-409-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND344600000X
3747P1801X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant