Provider Demographics
NPI:1376212761
Name:KEYNAN, UBAH (FNP)
Entity Type:Individual
Prefix:
First Name:UBAH
Middle Name:
Last Name:KEYNAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2860
Mailing Address - Country:US
Mailing Address - Phone:612-822-1297
Mailing Address - Fax:
Practice Address - Street 1:5200 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3104
Practice Address - Country:US
Practice Address - Phone:763-400-3628
Practice Address - Fax:763-342-4183
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily