Healthcare Provider Details

I. General information

NPI: 1427911510
Provider Name (Legal Business Name): GLADYS NDIKE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9974 190TH AVE NW
ELK RIVER MN
55330-2459
US

IV. Provider business mailing address

9974 190TH AVE NW
ELK RIVER MN
55330-2459
US

V. Phone/Fax

Practice location:
  • Phone: 651-815-8185
  • Fax:
Mailing address:
  • Phone: 651-815-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13692
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: