Provider Demographics
NPI:1720544042
Name:MENGFON, NORBERT MB
Entity type:Individual
Prefix:
First Name:NORBERT
Middle Name:MB
Last Name:MENGFON
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 1:741 IRWIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1252
Mailing Address - Country:US
Mailing Address - Phone:585-281-9865
Mailing Address - Fax:
Practice Address - Street 1:741 IRWIN ST APT 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1252
Practice Address - Country:US
Practice Address - Phone:585-281-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7753213OtherID