Provider Demographics
NPI:1891526885
Name:NKENGAFAC, VIVIENNE T (CNP)
Entity type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:T
Last Name:NKENGAFAC
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VIVIENNE
Other - Middle Name:T
Other - Last Name:TASONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 SALINGER DR
Mailing Address - Street 2:
Mailing Address - City:LITHOPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:43136-9780
Mailing Address - Country:US
Mailing Address - Phone:614-615-7385
Mailing Address - Fax:
Practice Address - Street 1:213 SALINGER DR
Practice Address - Street 2:
Practice Address - City:LITHOPOLIS
Practice Address - State:OH
Practice Address - Zip Code:43136-9780
Practice Address - Country:US
Practice Address - Phone:614-615-7385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
OHAPRN.CNP.0037250163WP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health