MEDICARE: OGBONNAYA I NWANKWO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility		MN

General Provider Information

NPI Number	:	1548199516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OGBONNAYA I NWANKWO

Provider Business Mailing Address
First Line	:	11430 47TH AVE N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55442-2903
Country	:	US
Telephone Number	:	646-244-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	11430 47TH AVE N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55442-2903
Country	:	US
Telephone Number	:	646-244-9983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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Directions to “ OGBONNAYA I NWANKWO ” Practice Location

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