Healthcare Provider Details

I. General information

NPI: 1396665360
Provider Name (Legal Business Name): KARISSA NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KARISSA IMENA FLIEHS

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S 3RD ST
MINNEAPOLIS MN
55415-1104
US

IV. Provider business mailing address

614 S 3RD ST
MINNEAPOLIS MN
55415-1104
US

V. Phone/Fax

Practice location:
  • Phone: 952-460-0299
  • Fax:
Mailing address:
  • Phone: 952-460-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2473962
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: