Provider Demographics
NPI:1356946636
Name:NYOKWOYO, MALACK A (DNP)
Entity type:Individual
Prefix:
First Name:MALACK
Middle Name:A
Last Name:NYOKWOYO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 S COUNTY ROAD 45
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5113
Mailing Address - Country:US
Mailing Address - Phone:612-454-2132
Mailing Address - Fax:507-451-2705
Practice Address - Street 1:2480 COUNTY ROAD 45
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060
Practice Address - Country:US
Practice Address - Phone:612-454-2130
Practice Address - Fax:507-451-2705
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7920363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health