Provider Demographics
NPI:1154085777
Name:GEKONGE, CONCEPTER NYASUGUTA (APRN; FNP)
Entity Type:Individual
Prefix:
First Name:CONCEPTER
Middle Name:NYASUGUTA
Last Name:GEKONGE
Suffix:
Gender:F
Credentials:APRN; FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 LYNDALE AVE S # 3060
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2742
Mailing Address - Country:US
Mailing Address - Phone:952-881-0163
Mailing Address - Fax:
Practice Address - Street 1:6588 BLUESTEM LN S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4488
Practice Address - Country:US
Practice Address - Phone:651-324-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily