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General NPI Number Information
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NPI Number | 1861845281
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Entity Type | Individual
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Provider Name | SAMUEL NWANEKPE
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Gender | Male
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 1821 UNIVERSITY AVE W STE S348
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City | SAINT PAUL
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State | MN
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Zip | 55104-2876
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Country | US
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Telephone | 651-493-3834
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Fax | 651-493-3835
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Provider Business Mailing Address
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Address Line | 2623 GREY EAGLE DR
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City | WOODBURY
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State | MN
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Zip | 55129-4297
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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 | 11050
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License Number State | MN
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