Provider Demographics
NPI:1437649928
Name:KENGNE, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KENGNE
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 1:7601 36TH AVE N APT 205
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2070
Mailing Address - Country:US
Mailing Address - Phone:773-430-1057
Mailing Address - Fax:
Practice Address - Street 1:2301 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3709
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:612-781-3837
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-05-14
Deactivation Date:2021-04-10
Deactivation Code:
Reactivation Date:2021-05-13
Provider Licenses
StateLicense IDTaxonomies
MN5836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty