Individual
PASCALINE MAMBO NDIFOR SUHFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-4786
Mailing address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-4786
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10599
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1809161
NURSING
MN
Enumeration date
09/11/2020
Last updated
01/11/2024
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