Provider Demographics
NPI:1720865272
Name:FANDIO NGANKOU, EDWIGE HERMINE (APRN)
Entity type:Individual
Prefix:
First Name:EDWIGE
Middle Name:HERMINE
Last Name:FANDIO NGANKOU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 W CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2484
Mailing Address - Country:US
Mailing Address - Phone:702-763-7811
Mailing Address - Fax:
Practice Address - Street 1:2021 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3137
Practice Address - Country:US
Practice Address - Phone:702-899-1208
Practice Address - Fax:702-778-7632
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN97594163W00000X
NV870658363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse