Healthcare Provider Details

I. General information

NPI: 1982514725
Provider Name (Legal Business Name): GYALTSEN NORBU IOM TECHNOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5109 BRIGHTON LN
SAINT PAUL MN
55112-4845
US

IV. Provider business mailing address

5109 BRIGHTON LN
SAINT PAUL MN
55112-4845
US

V. Phone/Fax

Practice location:
  • Phone: 952-564-4156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: