Healthcare Provider Details

I. General information

NPI: 1427989144
Provider Name (Legal Business Name): SYNTISHE NSANGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 18TH ST S
MOORHEAD MN
56560-7056
US

IV. Provider business mailing address

2285 STEWART AVE APT 2403
SAINT PAUL MN
55116-3173
US

V. Phone/Fax

Practice location:
  • Phone: 218-422-5346
  • Fax:
Mailing address:
  • Phone: 218-422-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: