Individual
MARGUERITE NANCY KIBIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
755 53RD AVE NE, FRIDLEY, MN 55421-1240
(866) 389-2727
Mailing address
755 53RD AVE NE, FRIDLEY, MN 55421-1240
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9010
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119796
MEDICA
—
01
—
106468
U CARE MEDICAL ASSIST
—
01
—
106468C620
U CARE FOR SENIOR
—
05
—
277590500
—
MN
01
—
FP14201016107
PREFERRED ONE
—
Enumeration date
08/10/2005
Last updated
12/05/2018
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