Provider Demographics
NPI:1699589440
Name:FONKENG, CONSOLAR NGANG
Entity type:Individual
Prefix:
First Name:CONSOLAR
Middle Name:NGANG
Last Name:FONKENG
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 1:5328 N 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1406
Mailing Address - Country:US
Mailing Address - Phone:402-707-8373
Mailing Address - Fax:
Practice Address - Street 1:5328 N 47TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1406
Practice Address - Country:US
Practice Address - Phone:402-707-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62559376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty