Provider Demographics
NPI:1962766360
Name:ETIENDEM, NGWI RITA (HHA)
Entity type:Individual
Prefix:MS
First Name:NGWI
Middle Name:RITA
Last Name:ETIENDEM
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44202 W GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8868
Mailing Address - Country:US
Mailing Address - Phone:480-667-8101
Mailing Address - Fax:
Practice Address - Street 1:44202 W GRANITE DR APT 43
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8868
Practice Address - Country:US
Practice Address - Phone:480-667-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238002163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health