Healthcare Provider Details

I. General information

NPI: 1487586384
Provider Name (Legal Business Name): NOVA HEALTH & WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CEDAR AVE S
MINNEAPOLIS MN
55454-1032
US

IV. Provider business mailing address

405 CEDAR AVE S
MINNEAPOLIS MN
55454-1032
US

V. Phone/Fax

Practice location:
  • Phone: 612-472-1556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: ABDULRAHMAN ALI
Title or Position: ADMIN
Credential:
Phone: 612-472-1556