Provider Demographics
NPI:1467141077
Name:TOWOUH, WELEMATOR
Entity Type:Individual
Prefix:
First Name:WELEMATOR
Middle Name:
Last Name:TOWOUH
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 1:14701 COBALT ST NW UNIT 15
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-3071
Mailing Address - Country:US
Mailing Address - Phone:850-841-9172
Mailing Address - Fax:651-262-0300
Practice Address - Street 1:14701 COBALT ST NW UNIT 15
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-3071
Practice Address - Country:US
Practice Address - Phone:850-841-9172
Practice Address - Fax:651-262-0300
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376J00000X, 374U00000X
372500000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion