Provider Demographics
NPI:1447870555
Name:SHANKA, URGO
Entity type:Individual
Prefix:
First Name:URGO
Middle Name:
Last Name:SHANKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 LARPENTEUR AVE W APT 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6325
Mailing Address - Country:US
Mailing Address - Phone:651-440-5329
Mailing Address - Fax:
Practice Address - Street 1:1270 LARPENTEUR AVE W APT 103
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6325
Practice Address - Country:US
Practice Address - Phone:651-440-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2475359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty