Individual provider Active NPI

Zamzam Abdirahman Mohamed

  • Registered Nurse
  • Minneapolis, MN
National Provider Identifier
1295525004
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
2459129 Issued in MN
Practice address
121 Hennepin Ave
Minneapolis, MN 55401-1802
Phone
(612) 412-3318
Fax
(612) 288-1805
NPI assigned
May 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2459129 MN Primary

Addresses

Primary practice location

121 Hennepin Ave
Minneapolis, MN 55401-1802

Mailing address

121 Hennepin Ave
Minneapolis, MN 55401-1802
Phone (612) 412-3318

Other practice location 1

4640 Slater Rd Ste 100
Eagan, MN 55122-4044
Phone (612) 412-3318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2459129MNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Lakes Counseling Services LLC CurrentSince May 11, 2025 Accepting new patients
Optimal Wellness Services LLC PastSince Jul 9, 2025 Accepting new patients

Locations

4640 Slater Rd
Ste 100
Eagan, MN 55122
Phone (612) 412-3318

121 Hennepin Ave
Minneapolis, MN 55401
Phone (612) 354-2424

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1295525004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 HENNEPIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554011802",
            "telephone_number": "612-412-3318",
            "fax_number": "612-288-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 HENNEPIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554011802",
            "telephone_number": "612-412-3318",
            "fax_number": "612-288-1805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4640 Slater Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551224044",
            "country_code": "US",
            "telephone_number": "612-412-3318",
            "fax_number": "612-288-1805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "ZAMZAM",
        "middle_name": "ABDIRAHMAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2459129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.