Individual
NINA PHILICIA BANGU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
18837 SMITH DR NW, ELK RIVER, MN 55330-7510
(763) 291-1069
Mailing address
18837 SMITH DR NW, ELK RIVER, MN 55330-7510
(763) 291-1069
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
1103992
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001057364
WAIVERS
MN
Enumeration date
05/06/2020
Last updated
05/06/2020
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