Provider Demographics
NPI:1073098802
Name:NDANG, FELIX
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:NDANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 SCARLETT OAK DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-4171
Mailing Address - Country:US
Mailing Address - Phone:708-268-2034
Mailing Address - Fax:
Practice Address - Street 1:7707 SCARLETT OAK DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-4171
Practice Address - Country:US
Practice Address - Phone:708-268-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.115926364SS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SS0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistSchoolGroup - Single Specialty