Provider Demographics
NPI:1407677909
Name:NYABUTI, NANCY
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:NYABUTI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KINARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7960 ORCHID LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2186
Mailing Address - Country:US
Mailing Address - Phone:612-807-0456
Mailing Address - Fax:
Practice Address - Street 1:13603 80TH CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-8961
Practice Address - Country:US
Practice Address - Phone:763-274-3120
Practice Address - Fax:763-274-3121
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional