Provider Demographics
NPI:1114180759
Name:NGONA, EUSTUS KALUBA
Entity Type:Individual
Prefix:
First Name:EUSTUS
Middle Name:KALUBA
Last Name:NGONA
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 1:7348 TIMBER CREST DR S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4577
Mailing Address - Country:US
Mailing Address - Phone:507-219-2072
Mailing Address - Fax:
Practice Address - Street 1:7348 TIMBER CREST DR S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4577
Practice Address - Country:US
Practice Address - Phone:507-219-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR176943-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse