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General NPI Number Information
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NPI Number | 1598445967
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Entity Type | Individual
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Provider Name | ALIYAH JEROME CNP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 5700 BOTTINEAU BLVD STE 210
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City | CRYSTAL
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State | MN
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Zip | 55429-3184
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Country | US
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Telephone | 763-330-2774
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Fax | 763-330-2775
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1786
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2476407
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License Number State | MN
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