Provider Demographics
NPI:1043069214
Name:GITENYA, ROSE NYABOKE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:NYABOKE
Last Name:GITENYA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 94TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1181
Mailing Address - Country:US
Mailing Address - Phone:651-307-3149
Mailing Address - Fax:
Practice Address - Street 1:1140 SKILLMAN AVE W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5938
Practice Address - Country:US
Practice Address - Phone:612-239-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2523649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse