Provider Demographics
NPI:1326330382
Name:GITONGU, SAMUEL KIBE (LPN)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KIBE
Last Name:GITONGU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 HAUT BRION AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4538
Mailing Address - Country:US
Mailing Address - Phone:302-753-3696
Mailing Address - Fax:
Practice Address - Street 1:136 HAUT BRION AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4538
Practice Address - Country:US
Practice Address - Phone:302-753-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0009902164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse