Provider Demographics
NPI:1265190722
Name:OGAMBA, GILBERT NYAKUNDI
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:NYAKUNDI
Last Name:OGAMBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9699 KNIGHTSBRIDGE RD APT 26
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4317
Mailing Address - Country:US
Mailing Address - Phone:952-228-1472
Mailing Address - Fax:
Practice Address - Street 1:8357 116TH WAY N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2725
Practice Address - Country:US
Practice Address - Phone:952-228-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2064714163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty