Provider Demographics
NPI:1588913024
Name:KHAMBACHE, NAWANG K (NP)
Entity type:Individual
Prefix:
First Name:NAWANG
Middle Name:K
Last Name:KHAMBACHE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:NAWANG
Other - Middle Name:K
Other - Last Name:SHERPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:420 E SARNIA ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6365
Mailing Address - Country:US
Mailing Address - Phone:507-454-3650
Mailing Address - Fax:507-474-3392
Practice Address - Street 1:420 E SARNIA ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6365
Practice Address - Country:US
Practice Address - Phone:507-454-3650
Practice Address - Fax:507-474-3392
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR183231-6363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily