Provider Demographics
NPI:1356814891
Name:ONSOMU, IRENE YUNESI
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:YUNESI
Last Name:ONSOMU
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 1:5206 SCOTT TRL
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2069
Mailing Address - Country:US
Mailing Address - Phone:763-300-3433
Mailing Address - Fax:
Practice Address - Street 1:5206 SCOTT TRL
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2069
Practice Address - Country:US
Practice Address - Phone:763-300-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2004855163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health