Provider Demographics
NPI:1598295834
Name:KAMANDE, GEORGE NGUGI (CNP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:NGUGI
Last Name:KAMANDE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE
Mailing Address - Street 2:STE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-587-7737
Mailing Address - Fax:763-587-7069
Practice Address - Street 1:1055 WESTGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1451
Practice Address - Country:US
Practice Address - Phone:651-635-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN5169363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care