Provider Demographics
NPI:1295608859
Name:ELVIS, NGWESSE AJANG SR (CPR,CG,AD)
Entity type:Individual
Prefix:MR
First Name:NGWESSE
Middle Name:AJANG
Last Name:ELVIS
Suffix:SR
Gender:M
Credentials:CPR,CG,AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16417 ERNEST CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3283
Mailing Address - Country:US
Mailing Address - Phone:405-510-4341
Mailing Address - Fax:
Practice Address - Street 1:16417 ERNEST CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3283
Practice Address - Country:US
Practice Address - Phone:405-510-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty