Provider Demographics
NPI:1093582017
Name:NGWESSE, SHIRLEY DOWON
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DOWON
Last Name:NGWESSE
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 1:2761 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6335
Mailing Address - Country:US
Mailing Address - Phone:612-443-8611
Mailing Address - Fax:
Practice Address - Street 1:2761 15TH ST NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6335
Practice Address - Country:US
Practice Address - Phone:612-443-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty