Individual
KENNETH IGWACHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3515 CENTURY AVE N APT 201B, WHITE BEAR LAKE, MN 55110-5667
(651) 424-7922
Mailing address
3515 CENTURY AVE N APT 201B, WHITE BEAR LAKE, MN 55110-5667
(651) 424-7922
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2491231
MN
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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