Provider Demographics
NPI:1558886960
Name:KABA, LILIAN D (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:D
Last Name:KABA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 IRVING AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2516
Mailing Address - Country:US
Mailing Address - Phone:612-441-2024
Mailing Address - Fax:800-440-5458
Practice Address - Street 1:3101 IRVING AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2516
Practice Address - Country:US
Practice Address - Phone:612-441-2024
Practice Address - Fax:800-440-5458
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2250638163W00000X
MN10015363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse