Provider Demographics
NPI:1235611567
Name:BESONG, RACHEAL EBANGHA (RN)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:EBANGHA
Last Name:BESONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 VITRUVIAN WAY APT 1907
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4088
Mailing Address - Country:US
Mailing Address - Phone:386-366-3461
Mailing Address - Fax:
Practice Address - Street 1:3925 VITRUVIAN WAY APT 1907
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4088
Practice Address - Country:US
Practice Address - Phone:386-366-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA148980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse