Provider Demographics
NPI:1629810916
Name:RIBOMBO, THULISILE SANDRA
Entity type:Individual
Prefix:
First Name:THULISILE
Middle Name:SANDRA
Last Name:RIBOMBO
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 1:129 MARSHALL LOOP
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-1001
Mailing Address - Country:US
Mailing Address - Phone:218-979-1723
Mailing Address - Fax:
Practice Address - Street 1:129 MARSHALL LOOP
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-1001
Practice Address - Country:US
Practice Address - Phone:218-979-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty