Individual
TIMOTHY LEODYU GBEHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
715 S 8TH ST, MINNEAPOLIS, MN 55404-7530
(612) 873-6963
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
9704
MN
363LG0600X
Gerontology Nurse Practitioner
9704
MN
Other
Enumeration date
11/08/2022
Last updated
11/18/2024
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