Provider Demographics
NPI:1326567082
Name:MOKUA, EDWIN NYANGENA
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:NYANGENA
Last Name:MOKUA
Suffix:
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 1:14994 SNOWY OWL ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4395
Mailing Address - Country:US
Mailing Address - Phone:651-703-2666
Mailing Address - Fax:
Practice Address - Street 1:14994 SNOWY OWL ST NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4395
Practice Address - Country:US
Practice Address - Phone:651-703-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2338123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse