Active NPI
Ernestine Mambo
- Family Nurse Practitioner
- Anoka, MN
National Provider Identifier
1801240205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP4350
- Practice address
- 3301 7TH Ave
Anoka, MN 55303-4516 - Phone
- (651) 431-5000
- NPI assigned
- Apr 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP4350 | MN | Primary |
Addresses
Primary practice location
3301 7TH Ave
Anoka, MN 55303-4516
Mailing address
13100 Bittersweet St NW
Minneapolis, MN 55448-1210
Phone (651) 408-5286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4350 | MN | MD | Marriage & Family Therapist |
| CNP4350 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493078400000",
"number": "1801240205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13100 BITTERSWEET ST NW",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554481210",
"telephone_number": "651-408-5286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 7TH AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "553034516",
"telephone_number": "651-431-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMBO",
"first_name": "ERNESTINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-21",
"last_updated": "2017-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "CNP4350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.