Provider Demographics
NPI:1114602380
Name:NGWA, ELSIE MANKAA (PMHNP)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:MANKAA
Last Name:NGWA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 CLEVELAND LN S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-7102
Mailing Address - Country:US
Mailing Address - Phone:651-285-9077
Mailing Address - Fax:
Practice Address - Street 1:2109 CLEVELAND LN S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-7102
Practice Address - Country:US
Practice Address - Phone:651-285-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1953363163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health