Provider Demographics
NPI:1295562619
Name:NKANSAH, MAVIS
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:NKANSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 ANDERSON LAKES PKWY APT 305N
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-4112
Mailing Address - Country:US
Mailing Address - Phone:952-457-1836
Mailing Address - Fax:
Practice Address - Street 1:14039 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-6405
Practice Address - Country:US
Practice Address - Phone:719-725-0712
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10635651376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide