Individual
SIMON MOMANYI NYAMARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1705 SOUTHCROSS DR W STE 105, BURNSVILLE, MN 55306-7012
(952) 683-1628
(952) 683-1629
Mailing address
1705 SOUTHCROSS DR W STE 105, BURNSVILLE, MN 55306-7012
(952) 683-1628
(952) 683-1629
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R1704787
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A116450100
CADI WAIVER MA
MN
01
—
A836410600
MA CADI WAIVER
MN
Enumeration date
03/05/2020
Last updated
03/05/2020
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