Provider Demographics
NPI:1053703447
Name:HASSAN, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
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 1:212 DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5184
Mailing Address - Country:US
Mailing Address - Phone:507-351-8830
Mailing Address - Fax:
Practice Address - Street 1:500 FOREST AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1541
Practice Address - Country:US
Practice Address - Phone:207-409-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12223645000027343900000X
ME3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)