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General NPI Number Information
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NPI Number | 1487112652
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Entity Type | Individual
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Provider Name | PRUDENCE MPOFU FNP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 750 E 34TH ST
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City | HIBBING
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State | MN
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Zip | 55746-2341
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Country | US
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Telephone | 218-262-4881
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 PATRICK CT APT 107
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City | WATERLOO
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State | IA
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Zip | 50701-4405
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A140430
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License Number State | IA
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