Healthcare Provider Details

I. General information

NPI: 1407430473
Provider Name (Legal Business Name): KEJELA HAJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 METRO BLVD
EDINA MN
55439-3081
US

IV. Provider business mailing address

656 GLENBROOK AVE N
OAKDALE MN
55128-6507
US

V. Phone/Fax

Practice location:
  • Phone: 952-914-1720
  • Fax: 952-914-1727
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number8163
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: