Provider Demographics
NPI:1154105708
Name:ABONGWA, NANCY N (PMHNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:N
Last Name:ABONGWA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 AVENIDA HACIENDA
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4701
Mailing Address - Country:US
Mailing Address - Phone:310-988-6966
Mailing Address - Fax:
Practice Address - Street 1:2067 AVENIDA HACIENDA
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-4701
Practice Address - Country:US
Practice Address - Phone:310-988-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026607363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health