| Doctor Name: | MRS. GRACE OGHENEKARO OYEFESOBI |
| NPI Number: | 1184070591 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4351 |
| Business Practice Address: | 2882 Middle St Little Canada, MN - 551171411 |
| Business Phone Number: | 6517894902 |
| Business Fax Number: | |
| Mailing Address: | 325 E Jackson St, ANOKA |
| State: | MN |
| Postal Code: | 553032210 |
| Phone Number: | 7633235085 |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2016 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |