Healthcare Provider Details

I. General information

NPI: 1407775521
Provider Name (Legal Business Name): ISABELLE EBANGA ATEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SNELLING AVE N
SAINT PAUL MN
55104-2878
US

IV. Provider business mailing address

625 SNELLING AVE N
SAINT PAUL MN
55104-2878
US

V. Phone/Fax

Practice location:
  • Phone: 952-288-9921
  • Fax:
Mailing address:
  • Phone: 651-442-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14450
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: