Provider Demographics
NPI:1306238555
Name:SANGARE, INZA V (LPN)
Entity type:Individual
Prefix:
First Name:INZA
Middle Name:
Last Name:SANGARE
Suffix:V
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:INZA
Other - Middle Name:
Other - Last Name:SANGARE
Other - Suffix:V
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1100 FRANKLIN AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5575
Mailing Address - Country:US
Mailing Address - Phone:646-319-0204
Mailing Address - Fax:
Practice Address - Street 1:1100 FRANKLIN AVE APT 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5575
Practice Address - Country:US
Practice Address - Phone:646-319-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316718164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY316718OtherLPN