Provider Demographics
NPI:1679074850
Name:MORWABE, THOMAS OSEBE
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:OSEBE
Last Name:MORWABE
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 1:9005 OLD CEDAR AVE S APT 104
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-2326
Mailing Address - Country:US
Mailing Address - Phone:612-298-0392
Mailing Address - Fax:
Practice Address - Street 1:9005 OLD CEDAR AVE S APT 104
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-2326
Practice Address - Country:US
Practice Address - Phone:612-298-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN232948-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse