Provider Demographics
NPI:1326675737
Name:NDINGWAN, MAMBO JINGLA (DNP-FPMHNP)
Entity Type:Individual
Prefix:
First Name:MAMBO
Middle Name:JINGLA
Last Name:NDINGWAN
Suffix:
Gender:F
Credentials:DNP-FPMHNP
Other - Prefix:DR
Other - First Name:MAMBO
Other - Middle Name:JINGLA
Other - Last Name:NDINGWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP-FPMHNP
Mailing Address - Street 1:3009 SKINNER DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3146
Mailing Address - Country:US
Mailing Address - Phone:209-719-0244
Mailing Address - Fax:
Practice Address - Street 1:111 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3001
Practice Address - Country:US
Practice Address - Phone:401-462-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02295363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health