Healthcare Provider Details

I. General information

NPI: 1184534604
Provider Name (Legal Business Name): NENE SHERIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 HOLLY LN N
MAPLE GROVE MN
55311-1274
US

IV. Provider business mailing address

9105 HOLLY LN N
MAPLE GROVE MN
55311-1274
US

V. Phone/Fax

Practice location:
  • Phone: 612-466-1062
  • Fax:
Mailing address:
  • Phone: 612-466-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number425406
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: