Healthcare Provider Details

I. General information

NPI: 1477468445
Provider Name (Legal Business Name): KEYSTONE HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E GRANT ST
MINNEAPOLIS MN
55404-1411
US

IV. Provider business mailing address

505 E GRANT ST
MINNEAPOLIS MN
55404-1411
US

V. Phone/Fax

Practice location:
  • Phone: 314-704-3933
  • Fax: 763-358-9855
Mailing address:
  • Phone: 314-704-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SAREEDO A HASHI
Title or Position: NP
Credential: HASHI
Phone: 314-704-3933