Provider Demographics
NPI:1083094502
Name:NIAGAWOE, TUOQUELLIE G JR
Entity Type:Individual
Prefix:MR
First Name:TUOQUELLIE
Middle Name:G
Last Name:NIAGAWOE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 DUPONT AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1211
Mailing Address - Country:US
Mailing Address - Phone:612-387-1636
Mailing Address - Fax:651-344-0590
Practice Address - Street 1:7001 DUPONT AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1211
Practice Address - Country:US
Practice Address - Phone:612-387-1636
Practice Address - Fax:651-344-0590
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN814789800024172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver