Healthcare Provider Details

I. General information

NPI: 1548148976
Provider Name (Legal Business Name): BLESSING OSIBODU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLESSING AGHAYEDO FNP

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2522
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-6000
  • Fax: 763-236-8410
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13116
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: