Provider Demographics
NPI:1427468040
Name:NGANJE, FAVOUR GRACE
Entity type:Individual
Prefix:
First Name:FAVOUR
Middle Name:GRACE
Last Name:NGANJE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 ELAINE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-5602
Mailing Address - Country:US
Mailing Address - Phone:614-735-1746
Mailing Address - Fax:
Practice Address - Street 1:4076 ELAINE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-5602
Practice Address - Country:US
Practice Address - Phone:614-735-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155987164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3049418OtherMEDICARE, INDEPENDENT PROVIDER