Provider Demographics
NPI:1316670052
Name:OMUKHANGO, MARTIN ELKANAH (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ELKANAH
Last Name:OMUKHANGO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3756
Mailing Address - Country:US
Mailing Address - Phone:412-734-1100
Mailing Address - Fax:
Practice Address - Street 1:362 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3756
Practice Address - Country:US
Practice Address - Phone:412-734-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily