Provider Demographics
NPI:1598590556
Name:NKINZINGABO, DESIRE B
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:B
Last Name:NKINZINGABO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4272 31ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8725
Mailing Address - Country:US
Mailing Address - Phone:701-200-3783
Mailing Address - Fax:
Practice Address - Street 1:4272 31ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8725
Practice Address - Country:US
Practice Address - Phone:701-200-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253J00000XAgenciesFoster Care Agency