Mrs Mirabel Tibuji Mambo, in Elk River, MN - Medicare Nurse Practitioner

Mrs Mirabel Tibuji Mambo, is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Elk River, Minnesota. Her current practice location is 19097 Baldwin St Nw, Elk River, Minnesota. You can reach out to her office (for appointments etc.) via phone at (763) 328-4738.

Mrs Mirabel Tibuji Mambo is licensed to practice in Minnesota (license number 9433) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1639888092.

Contact Information

	Mrs Mirabel Tibuji Mambo,
	19097 Baldwin St Nw, Elk River, MN 55330-2813
	(763) 328-4738
	Not Available

Map and Direction

Provider's Profile

Full Name	Mrs Mirabel Tibuji Mambo
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	19097 Baldwin St Nw, Elk River, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1639888092
Provider Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022

Medicare PECOS Information:

PECOS PAC ID: 6800243478
Enrollment ID: I20231103003202

Medical Identifiers

Medical identifiers for Mrs Mirabel Tibuji Mambo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1639888092	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	9433 (Minnesota)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Mirabel Tibuji Mambo allows following entities to bill medicare on her behalf.

Entity Name	Diamond Lake Clinic, P.c.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1740669498 PECOS PAC ID: 8022324664 Enrollment ID: O20150827002511

Entity Name	Eir Med Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1912579244 PECOS PAC ID: 6002218757 Enrollment ID: O20210716002477

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Mirabel Tibuji Mambo is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Mirabel Tibuji Mambo, 19097 Baldwin St Nw, Elk River, MN 55330-2813 Ph: (763) 328-4738	Mrs Mirabel Tibuji Mambo, 19097 Baldwin St Nw, Elk River, MN 55330-2813 Ph: (763) 328-4738

Reviews and Comments

Nurse Practitioner Nurses in Elk River, MN

Melissa Christensen Froehlich, PNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 530 3rd St Nw, Elk River, MN 55330 Phone: 763-587-4800 Fax: 763-587-4845
Elizabeth Mclean, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 290 Main St Nw, Elk River, MN 55330 Phone: 763-241-0373
Nancy Jean Pierro, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 14181 Business Center Dr Nw, Elk River, MN 55330 Phone: 763-236-0500
Kelly Vevea, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 290 Main St Nw, Elk River, MN 55330 Phone: 612-672-2986
Sharon Marie Koep Dickey, MSN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 19425 Evans St Nw, Elk River, MN 55330 Phone: 763-389-7686
Mrs. Kimberly Dawn Bursch-tewalt, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 11884 237th Ave Nw, Elk River, MN 55330 Phone: 763-516-6777
Demitu Baissa-tesfahun, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 14181 Business Center Dr Nw, Elk River, MN 55330 Phone: 763-236-0500

Mrs Mirabel Tibuji Mambo, - Medicare Nurse Practitioner in Elk River, MN