Provider Demographics
NPI:1659045391
Name:NDEGE, GLADYS AYIERA (CNP)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:AYIERA
Last Name:NDEGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 SHENANDOAH LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-3201
Mailing Address - Country:US
Mailing Address - Phone:763-464-6462
Mailing Address - Fax:
Practice Address - Street 1:1145 SHENANDOAH LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-3201
Practice Address - Country:US
Practice Address - Phone:763-464-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND202185363LP0808X
OR10041687363LP0808X
MN8338363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health