Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | CNP 4123 | MN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4123 | MN |
NPI | 1942673447 |
---|---|
Provider Name | Ogbitse Maureen Atake |
First Address | Saint Paul, MN 55104-4201 |
Second Address | Saint Paul, MN 55104-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2015 |
Last Update Date | 15/10/2019 |