Provider Demographics
NPI:1700634474
Name:TABUKUM, FELICITAS MUHAN
Entity type:Individual
Prefix:
First Name:FELICITAS
Middle Name:MUHAN
Last Name:TABUKUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 COON RAPIDS BLVD NW STE 260
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2597
Mailing Address - Country:US
Mailing Address - Phone:651-283-1185
Mailing Address - Fax:
Practice Address - Street 1:3833 COON RAPIDS BLVD NW STE 260
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2597
Practice Address - Country:US
Practice Address - Phone:651-283-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1772890163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice