Healthcare Provider Details

I. General information

NPI: 1598013906
Provider Name (Legal Business Name): EMILLY MORAA ONDARA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 SKYLINE DR N
BURNSVILLE MN
55337-2928
US

IV. Provider business mailing address

1908 SKYLINE DR N
BURNSVILLE MN
55337-2928
US

V. Phone/Fax

Practice location:
  • Phone: 952-594-4862
  • Fax:
Mailing address:
  • Phone: 952-594-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number410602
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR206893-0
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2068930
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: