Healthcare Provider Details

I. General information

NPI: 1508518721
Provider Name (Legal Business Name): SARAH MUKTAR OSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 COLBORNE ST
SAINT PAUL MN
55102-3299
US

IV. Provider business mailing address

360 COLBORNE ST
SAINT PAUL MN
55102-3299
US

V. Phone/Fax

Practice location:
  • Phone: 651-744-5760
  • Fax:
Mailing address:
  • Phone: 651-744-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number236974-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: