Individual
MR. BONIFACE MWANGI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11137 FILLMORE ST NE, BLAINE, MN 55434-4524
(165) 123-5694
Mailing address
11137 FILLMORE ST NE, BLAINE, MN 55434-4524
(165) 123-5694
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
R193717-2
MN
163WH0200X
Home Health Registered Nurse
Primary
R193717-2
MN
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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