Provider Demographics
NPI:1215281225
Name:NZEMBAYIE, NGUM RENITA
Entity type:Individual
Prefix:
First Name:NGUM
Middle Name:RENITA
Last Name:NZEMBAYIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NGUM
Other - Middle Name:RENITA
Other - Last Name:NZEMBAYIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4195 SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1858
Mailing Address - Country:US
Mailing Address - Phone:614-477-9672
Mailing Address - Fax:
Practice Address - Street 1:4195 SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1858
Practice Address - Country:US
Practice Address - Phone:614-477-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.380468163W00000X
OHPN.147320164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse