Healthcare Provider Details

I. General information

NPI: 1528510195
Provider Name (Legal Business Name): NOHEMI ISABEL HABEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2179 4TH ST STE 2B
WHITE BEAR LAKE MN
55110-3041
US

IV. Provider business mailing address

2179 4TH ST STE 2B
WHITE BEAR LAKE MN
55110-3041
US

V. Phone/Fax

Practice location:
  • Phone: 651-705-7872
  • Fax:
Mailing address:
  • Phone: 651-705-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12278
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: