Healthcare Provider Details

I. General information

NPI: 1063340602
Provider Name (Legal Business Name): SAHRA SADIIQ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 FRANCE AVE S
EDINA MN
55410-2752
US

IV. Provider business mailing address

6122 FRANCE AVE S
EDINA MN
55410-2752
US

V. Phone/Fax

Practice location:
  • Phone: 612-501-5533
  • Fax:
Mailing address:
  • Phone: 612-501-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number13919
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: