Provider Demographics
NPI:1386213395
Name:XABA, SIMANGAYE (RN)
Entity Type:Individual
Prefix:
First Name:SIMANGAYE
Middle Name:
Last Name:XABA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ALIX RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7011
Mailing Address - Country:US
Mailing Address - Phone:914-468-3245
Mailing Address - Fax:
Practice Address - Street 1:10 ALIX RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7011
Practice Address - Country:US
Practice Address - Phone:914-468-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty