Provider Demographics
NPI:1841639093
Name:NGEGBA, JAMINE ESTHER
Entity type:Individual
Prefix:MS
First Name:JAMINE
Middle Name:ESTHER
Last Name:NGEGBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMINE
Other - Middle Name:ESTHER
Other - Last Name:NGEGBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11411 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2107
Mailing Address - Country:US
Mailing Address - Phone:678-933-7632
Mailing Address - Fax:
Practice Address - Street 1:11411 131ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2107
Practice Address - Country:US
Practice Address - Phone:678-933-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPO46831164W00000X
NY711032-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse