Provider Demographics
NPI:1891506226
Name:AREBA, CAROLINE KEMUNTO (RN, LPN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:KEMUNTO
Last Name:AREBA
Suffix:
Gender:F
Credentials:RN, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 STAGHORN DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5413
Mailing Address - Country:US
Mailing Address - Phone:952-254-7488
Mailing Address - Fax:
Practice Address - Street 1:3016 12TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1610
Practice Address - Country:US
Practice Address - Phone:612-598-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN781523164W00000X
MN2504545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse