Individual
MRS. MIRABEL TIBUJI MAMBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19097 BALDWIN ST NW, ELK RIVER, MN 55330-2813
(763) 328-4738
Mailing address
19097 BALDWIN ST NW, ELK RIVER, MN 55330-2813
(763) 328-4738
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9433
MN
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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