Provider Demographics
NPI:1932939949
Name:ENOKENWA, PRISCA BESSONG
Entity type:Individual
Prefix:
First Name:PRISCA
Middle Name:BESSONG
Last Name:ENOKENWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRISCA
Other - Middle Name:BESSONG
Other - Last Name:AYUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2703 PARADISE ISLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3910
Mailing Address - Country:US
Mailing Address - Phone:702-913-9946
Mailing Address - Fax:
Practice Address - Street 1:2703 PARADISE ISLE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3910
Practice Address - Country:US
Practice Address - Phone:702-913-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant