Individual
ALIYAH JEROME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
5700 BOTTINEAU BLVD STE 210, CRYSTAL, MN 55429-3184
(763) 330-2774
(763) 330-2775
Mailing address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2476407
MN
Other
Enumeration date
07/20/2023
Last updated
03/10/2025
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