Provider Demographics
NPI:1700687092
Name:GBOLOKAI, MICHAEL LT
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LT
Last Name:GBOLOKAI
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 1:4924 47TH ST S APT 106
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4418
Mailing Address - Country:US
Mailing Address - Phone:701-491-0103
Mailing Address - Fax:
Practice Address - Street 1:4924 47TH ST S APT 106
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4418
Practice Address - Country:US
Practice Address - Phone:701-491-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND57933376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide