Provider Demographics
NPI:1942932074
Name:SEVY-HASSAN, NATHANIEL
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:SEVY-HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WESTERN AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-254-7374
Mailing Address - Fax:
Practice Address - Street 1:450 SYNDICATE STREET N SUITE 300
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:952-541-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2023-03-16
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-03-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program