Provider Demographics
NPI:1558886960
Name:KABA, LILIAN D (RN)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:D
Last Name:KABA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:1099 10TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1312
Mailing Address - Country:US
Mailing Address - Phone:612-767-6272
Mailing Address - Fax:612-767-6273
Practice Address - Street 1:1099 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1312
Practice Address - Country:US
Practice Address - Phone:612-767-6272
Practice Address - Fax:612-767-6273
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2250638163W00000X
MN10015363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse