Provider Demographics
NPI:1871387183
Name:ENYONG, LAURA MBAYI (CTRS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MBAYI
Last Name:ENYONG
Suffix:
Gender:
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 SHEPARD RD APT 106
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3223
Mailing Address - Country:US
Mailing Address - Phone:651-347-7715
Mailing Address - Fax:
Practice Address - Street 1:2061 SHEPARD RD APT 106
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3223
Practice Address - Country:US
Practice Address - Phone:651-347-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist