Provider Demographics
NPI:1275786212
Name:ETENG, FLORA
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:
Last Name:ETENG
Suffix:
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 1:721 FAILE ST
Mailing Address - Street 2:APT 4E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-5937
Mailing Address - Country:US
Mailing Address - Phone:347-862-2297
Mailing Address - Fax:
Practice Address - Street 1:721 FAILE ST
Practice Address - Street 2:APT 4E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5937
Practice Address - Country:US
Practice Address - Phone:718-691-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292134164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse