Provider Demographics
NPI:1932569035
Name:OGATO, DAVID MAKONDE (CNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MAKONDE
Last Name:OGATO
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4624
Mailing Address - Country:US
Mailing Address - Phone:651-354-6602
Mailing Address - Fax:952-835-3895
Practice Address - Street 1:5325 W 74TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2231
Practice Address - Country:US
Practice Address - Phone:612-271-1181
Practice Address - Fax:651-571-0018
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4260363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health