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General NPI Number Information
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NPI Number | 1720959836
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Entity Type | Individual
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Provider Name | ELIJAH MACHOGU MABURURU
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Gender | Male
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Dates
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Enumeration Date | 09/13/2025
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Last Update Date | 10/25/2025
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Provider Practice Location Address
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Address Line | 7601 36TH AVE N
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City | NEW HOPE
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State | MN
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Zip | 55427-2014
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Country | US
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Telephone | 952-261-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 36TH AVE N APT 209
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City | NEW HOPE
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State | MN
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Zip | 55427-2070
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10248
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License Number State | MN
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