Provider Demographics
NPI:1801296546
Name:MAGHANGA, DOMITILA
Entity type:Individual
Prefix:
First Name:DOMITILA
Middle Name:
Last Name:MAGHANGA
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 1:4435 PARKLAWN CT APT 112
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4618
Mailing Address - Country:US
Mailing Address - Phone:952-393-0241
Mailing Address - Fax:
Practice Address - Street 1:4435 PARKLAWN CT APT 112
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4618
Practice Address - Country:US
Practice Address - Phone:952-393-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7637711000273747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant