Healthcare Provider Details

I. General information

NPI: 1417550948
Provider Name (Legal Business Name): JEREMIAH OTARO ONGERA APRN, CNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 DOUGLAS DR N STE 102
MINNEAPOLIS MN
55422-4397
US

IV. Provider business mailing address

PO BOX 47021
PLYMOUTH MN
55447-0021
US

V. Phone/Fax

Practice location:
  • Phone: 763-843-2833
  • Fax:
Mailing address:
  • Phone: 763-843-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12522
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-2299916
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: