Provider Demographics
NPI:1871227009
Name:NYAKUNDI, STELLA NYABOKE
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:NYABOKE
Last Name:NYAKUNDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:NYABOKE
Other - Last Name:OGEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC, PHN
Mailing Address - Street 1:1801 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3791
Mailing Address - Country:US
Mailing Address - Phone:763-213-9359
Mailing Address - Fax:
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3791
Practice Address - Country:US
Practice Address - Phone:763-213-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily