Healthcare Provider Details

I. General information

NPI: 1326640756
Provider Name (Legal Business Name): HIBA M SHARIF CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 SMITH AVE N STE 203
SAINT PAUL MN
55102-2388
US

IV. Provider business mailing address

614 SEARLES ST
NEW BRIGHTON MN
55112-2317
US

V. Phone/Fax

Practice location:
  • Phone: 952-486-3091
  • Fax:
Mailing address:
  • Phone: 952-486-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number448
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: