Provider Demographics
NPI:1912447780
Name:MULUBISHA, ZILLAH
Entity Type:Individual
Prefix:
First Name:ZILLAH
Middle Name:
Last Name:MULUBISHA
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 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-0000
Mailing Address - Fax:612-873-1957
Practice Address - Street 1:BROOKLYN PARK CLINIC
Practice Address - Street 2:7650 ZANE AVE N
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443
Practice Address - Country:US
Practice Address - Phone:612-873-0000
Practice Address - Fax:612-873-1957
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAG01170249363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care