Provider Demographics
NPI:1114220241
Name:NGONG, ROSE AKWEN II
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:AKWEN
Last Name:NGONG
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WORTHINGTON AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4343
Mailing Address - Country:US
Mailing Address - Phone:513-254-2007
Mailing Address - Fax:
Practice Address - Street 1:4 WORTHINGTON AVE
Practice Address - Street 2:APT 5
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-4343
Practice Address - Country:US
Practice Address - Phone:513-254-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138938164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse