Provider Demographics
NPI:1184429516
Name:ALAM, SANA BEBE
Entity type:Individual
Prefix:
First Name:SANA
Middle Name:BEBE
Last Name:ALAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1750
Mailing Address - Country:US
Mailing Address - Phone:763-245-1932
Mailing Address - Fax:
Practice Address - Street 1:16632 ENGLISH PATH
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5060
Practice Address - Country:US
Practice Address - Phone:763-245-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant