Provider Demographics
NPI:1427367093
Name:OGWANG, ZACHARIA G (FNP)
Entity Type:Individual
Prefix:MR
First Name:ZACHARIA
Middle Name:G
Last Name:OGWANG
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:
Practice Address - Street 1:15245 BLUEBIRD ST NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3538
Practice Address - Country:US
Practice Address - Phone:763-587-4600
Practice Address - Fax:763-587-4615
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner