Provider Demographics
NPI:1528744083
Name:NGWA, AGATHA
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:NGWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 LONDIN LN E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5543
Mailing Address - Country:US
Mailing Address - Phone:651-353-1912
Mailing Address - Fax:
Practice Address - Street 1:2302 LONDIN LN E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-5543
Practice Address - Country:US
Practice Address - Phone:651-353-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company