MEDICARE: LILIAN D KABA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2250638	MN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10015	MN

General Provider Information

NPI Number	:	1558886960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIAN D KABA PMHNP-BC

Provider Business Mailing Address
First Line	:	3101 IRVING AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2516
Country	:	US
Telephone Number	:	612-441-2024
Fax Number	:	800-440-5458

Provider Business Practice Location Address
First Line	:	3101 IRVING AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2516
Country	:	US
Telephone Number	:	612-441-2024
Fax Number	:	800-440-5458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	12/19/2024

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