Healthcare Provider Details

I. General information

NPI: 1992609085
Provider Name (Legal Business Name): SUBIS DINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15630 26TH AVE N APT C
PLYMOUTH MN
55447-5633
US

IV. Provider business mailing address

15630 26TH AVE N APT C
PLYMOUTH MN
55447-5633
US

V. Phone/Fax

Practice location:
  • Phone: 651-276-5922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: