Healthcare Provider Details

I. General information

NPI: 1154876233
Provider Name (Legal Business Name): SADIYA BULE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLOOMINGTON AVE
MINNEAPOLIS MN
55404-3074
US

IV. Provider business mailing address

2001 BLOOMINGTON AVE
MINNEAPOLIS MN
55404-3074
US

V. Phone/Fax

Practice location:
  • Phone: 612-301-3433
  • Fax:
Mailing address:
  • Phone: 612-301-3433
  • Fax: 612-426-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2460835
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5727
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: