Provider Demographics
NPI:1386994812
Name:FONGE, FELIX NGEH (NP)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:NGEH
Last Name:FONGE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SALT CREEK LN
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2926
Mailing Address - Country:US
Mailing Address - Phone:630-371-0133
Mailing Address - Fax:630-371-0138
Practice Address - Street 1:15 SALT CREEK LN
Practice Address - Street 2:SUITE 111
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2926
Practice Address - Country:US
Practice Address - Phone:630-371-0133
Practice Address - Fax:630-371-0138
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041342995163W00000X
IL209009800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse