Provider Demographics
NPI:1134818644
Name:SUBAH, SIENNEH
Entity type:Individual
Prefix:
First Name:SIENNEH
Middle Name:
Last Name:SUBAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 UNITY AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3226
Mailing Address - Country:US
Mailing Address - Phone:612-366-3935
Mailing Address - Fax:
Practice Address - Street 1:1300 HIDDEN LAKES PKWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4286
Practice Address - Country:US
Practice Address - Phone:763-533-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide