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General NPI Number Information
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NPI Number | 1134065527
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Entity Type | Individual
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Provider Name | CAMILLE TIBI MBAH TANGWAN
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Gender | Male
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 207 PICKERINGTON PONDS DR
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City | PICKERINGTON
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State | OH
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Zip | 43147-9970
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Country | US
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Telephone | 651-434-3104
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Fax | 651-434-3104
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Provider Business Mailing Address
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Address Line | 207 PICKERINGTON PONDS DR (651) 434-3104
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City | PICKERINGTON
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State | OH
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Zip | 43147-9970
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Country | US
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Telephone | 651-434-3104
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Fax | 651-434-3104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.534160
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License Number State | OH
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