Healthcare Provider Details

I. General information

NPI: 1912447780
Provider Name (Legal Business Name): ZILLAH MULUBISHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3776 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2629
US

IV. Provider business mailing address

2529 132ND LN NW
COON RAPIDS MN
55448-1205
US

V. Phone/Fax

Practice location:
  • Phone: 763-340-2330
  • Fax: 763-340-1444
Mailing address:
  • Phone: 763-340-2330
  • Fax: 763-340-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG01170249
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: