Healthcare Provider Details

I. General information

NPI: 1295380772
Provider Name (Legal Business Name): SANA QUADREE FASIHUDDIN ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 KIEFER RIDGE CT
BALLWIN MO
63021-6095
US

IV. Provider business mailing address

1118 KIEFER RIDGE CT
BALLWIN MO
63021-6095
US

V. Phone/Fax

Practice location:
  • Phone: 515-505-2837
  • Fax:
Mailing address:
  • Phone: 515-505-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015039385
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113683
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA155882
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: