Provider Demographics
NPI:1477347227
Name:TAMBWE, INNOCENT
Entity type:Individual
Prefix:
First Name:INNOCENT
Middle Name:
Last Name:TAMBWE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 15TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6928
Mailing Address - Country:US
Mailing Address - Phone:701-353-9832
Mailing Address - Fax:
Practice Address - Street 1:613 2ND ST SW APT 202
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4015
Practice Address - Country:US
Practice Address - Phone:701-353-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health