Provider Demographics
NPI:1649870825
Name:GAGA, EYITA (RN, CNM)
Entity type:Individual
Prefix:
First Name:EYITA
Middle Name:
Last Name:GAGA
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:EYITA
Other - Middle Name:OLJO
Other - Last Name:GAGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:1650 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4717
Mailing Address - Country:US
Mailing Address - Phone:507-529-6600
Mailing Address - Fax:
Practice Address - Street 1:1650 4TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4717
Practice Address - Country:US
Practice Address - Phone:507-529-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-182364-2163W00000X
MN459367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse