Provider Demographics
NPI:1972986974
Name:IGWACHO, JOSEPHINE AKOM (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:AKOM
Last Name:IGWACHO
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Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:1201 HARMON PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2043
Mailing Address - Country:US
Mailing Address - Phone:612-313-3240
Mailing Address - Fax:612-338-5902
Practice Address - Street 1:1201 HARMON PL
Practice Address - Street 2:SUITE 103
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2043
Practice Address - Country:US
Practice Address - Phone:612-313-3240
Practice Address - Fax:612-338-5902
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2017-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN4523363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health