Provider Demographics
NPI:1417550948
Name:ONGERA, JEREMIAH OTARO (RN)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:OTARO
Last Name:ONGERA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47021
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-0021
Mailing Address - Country:US
Mailing Address - Phone:763-843-2833
Mailing Address - Fax:
Practice Address - Street 1:8500 50TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55428-4117
Practice Address - Country:US
Practice Address - Phone:763-843-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-2299916163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse