Provider Demographics
NPI:1467704528
Name:NYABERE, WALTER OGETTI (NP)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:OGETTI
Last Name:NYABERE
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Gender:M
Credentials:NP
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Mailing Address - Street 1:8421 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2266
Mailing Address - Country:US
Mailing Address - Phone:952-212-0911
Mailing Address - Fax:651-300-1956
Practice Address - Street 1:8421 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445
Practice Address - Country:US
Practice Address - Phone:952-212-0911
Practice Address - Fax:651-300-1956
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2018-05-15
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Provider Licenses
StateLicense IDTaxonomies
MN0956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner