Provider Demographics
NPI:1619847167
Name:
Entity type:Organization
Organization Name:
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ONDARI
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:NYABUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-210-1561
Mailing Address - Street 1:9563 51ST ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-7529
Mailing Address - Country:US
Mailing Address - Phone:651-210-1561
Mailing Address - Fax:
Practice Address - Street 1:9563 51ST ST NE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-7529
Practice Address - Country:US
Practice Address - Phone:651-210-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company