Provider Demographics
NPI:1376295105
Name:ALONGE, SAMUEL IBUKUN
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:IBUKUN
Last Name:ALONGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 GARVEY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3175
Mailing Address - Country:US
Mailing Address - Phone:919-395-7032
Mailing Address - Fax:
Practice Address - Street 1:8470 GARVEY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3175
Practice Address - Country:US
Practice Address - Phone:919-395-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6371374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide