Provider Demographics
NPI:1144862996
Name:HAMZA, ALADE LATEEF (CNP)
Entity type:Individual
Prefix:
First Name:ALADE
Middle Name:LATEEF
Last Name:HAMZA
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 102ND TRL N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2293
Mailing Address - Country:US
Mailing Address - Phone:763-477-8151
Mailing Address - Fax:
Practice Address - Street 1:4808 85TH AVE N STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1816
Practice Address - Country:US
Practice Address - Phone:764-377-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6995363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care