Provider Demographics
NPI:1194427872
Name:ESEH, MARTHA LUMNGWEGANG (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LUMNGWEGANG
Last Name:ESEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 ARNOLD PALMER DR
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2554 LEWISVILLE CLEMMONS RD STE 305K
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8110
Practice Address - Country:US
Practice Address - Phone:336-283-7140
Practice Address - Fax:866-543-9146
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCESEH-Q3N09101Y00000X
NC5017881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor