Healthcare Provider Details

I. General information

NPI: 1508800285
Provider Name (Legal Business Name): SOUAD N BROBBY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOUAD NASHIEF PA

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 W 143RD ST STE 200
SAVAGE MN
55378-2890
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1010
  • Fax:
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04869
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11041
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: