Healthcare Provider Details

I. General information

NPI: 1114720703
Provider Name (Legal Business Name): FAITH NYAENYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAITH KERUBO NYAENYA PMHNP-BC

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BERKSHIRE LN N STE 250
PLYMOUTH MN
55446-3888
US

IV. Provider business mailing address

4100 BERKSHIRE LN N STE 250
PLYMOUTH MN
55446-3888
US

V. Phone/Fax

Practice location:
  • Phone: 612-223-8898
  • Fax:
Mailing address:
  • Phone: 612-223-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12333
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: