Provider Demographics
NPI:1003173733
Name:CADENGO, ANTONIO JR (RN)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CADENGO
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:CADENGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:401 BUSTER RD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-9792
Mailing Address - Country:US
Mailing Address - Phone:509-865-2102
Mailing Address - Fax:
Practice Address - Street 1:401 BUSTER RD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-9792
Practice Address - Country:US
Practice Address - Phone:509-865-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00176017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse