Individual
TRACY EBOSHOGUE ITSOSIME EKHATOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5701 SHINGLE CREEK PKWY, BROOKLYN CENTER, MN 55430-2467
(763) 453-8752
Mailing address
1543 159TH AVE NW, ANDOVER, MN 55304-4563
(763) 913-2216
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2521094
MN
Other
Enumeration date
09/28/2024
Last updated
09/28/2024
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