Provider Demographics
NPI:1699156349
Name:LEKENGE, RENE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:LEKENGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36626 GLADSTONE MILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1102
Mailing Address - Country:US
Mailing Address - Phone:440-409-3057
Mailing Address - Fax:
Practice Address - Street 1:36626 GLADSTONE MILL DR
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1102
Practice Address - Country:US
Practice Address - Phone:440-409-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN142608164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse