Provider Demographics
NPI:1821816638
Name:DOHNWANA, KINGSLEY
Entity type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:
Last Name:DOHNWANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 MARLYS DR W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2956
Mailing Address - Country:US
Mailing Address - Phone:701-541-9073
Mailing Address - Fax:
Practice Address - Street 1:1126 MARLYS DR W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2956
Practice Address - Country:US
Practice Address - Phone:701-541-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service