Individual
CALLEN B KIBAGENDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
100 WASHINGTON AVE S, MINNEAPOLIS, MN 55401-2110
(000) 000-0000
Mailing address
PO BOX 9382, NORTH SAINT PAUL, MN 55109-0382
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
8229
MN
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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