Healthcare Provider Details

I. General information

NPI: 1720016660
Provider Name (Legal Business Name): SASENARINE SINGH GNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 UNIVERSITY AVE W STE 115
SAINT PAUL MN
55104-3118
US

IV. Provider business mailing address

832 JASMINE AVE N
LAKE ELMO MN
55042
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2002
  • Fax: 651-232-2031
Mailing address:
  • Phone: 651-895-6193
  • Fax: 651-739-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR1117442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: