Healthcare Provider Details

I. General information

NPI: 1184429516
Provider Name (Legal Business Name): SANA BEBE ALAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 E LAKE ST
MINNEAPOLIS MN
55407-6700
US

IV. Provider business mailing address

2004 RANDOLPH AVE
SAINT PAUL MN
55105-1750
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-7175
  • Fax:
Mailing address:
  • Phone: 763-245-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: