Healthcare Provider Details

I. General information

NPI: 1215528344
Provider Name (Legal Business Name): NAS HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10907 XYLON LN N
CHAMPLIN MN
55316-3712
US

IV. Provider business mailing address

PO BOX 431114
BROOKLYN PARK MN
55443-7225
US

V. Phone/Fax

Practice location:
  • Phone: 763-477-8151
  • Fax:
Mailing address:
  • Phone: 763-477-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALADE LATEEF HAMZA
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 763-477-8151