Provider Demographics
NPI:1083593149
Name:KABONGO, KANYEBA LEILANI (APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KANYEBA
Middle Name:LEILANI
Last Name:KABONGO
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 W SHAW BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2427
Mailing Address - Country:US
Mailing Address - Phone:480-658-8513
Mailing Address - Fax:
Practice Address - Street 1:6428 W SHAW BUTTE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2427
Practice Address - Country:US
Practice Address - Phone:480-658-8513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ256903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty