Provider Demographics
NPI:1619463056
Name:AKPANG, MBUTAMBE ARREY (RN)
Entity Type:Individual
Prefix:MR
First Name:MBUTAMBE
Middle Name:ARREY
Last Name:AKPANG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 COUNTY ROAD 10 STE 112
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3064
Mailing Address - Country:US
Mailing Address - Phone:763-208-1797
Mailing Address - Fax:651-344-0590
Practice Address - Street 1:3300 COUNTY ROAD 10 STE 112
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3064
Practice Address - Country:US
Practice Address - Phone:763-208-1797
Practice Address - Fax:651-344-0590
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2029199163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1134454796Medicaid