MEDICARE: MR. BEN OAMEN AKHUETIE-ONI NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	R1546003-9	MN

General Provider Information

NPI Number	:	1689815755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BEN OAMEN AKHUETIE-ONI NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	10408 INDIANA AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1893
Country	:	US
Telephone Number	:	651-343-5154
Fax Number	:	651-227-6847

Provider Business Practice Location Address
First Line	:	330 MARIE AVE E
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-4011
Country	:	US
Telephone Number	:	651-343-5154
Fax Number	:	651-227-6847

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

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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