Provider Demographics
NPI:1386227973
Name:FANGU, ONITA VELMA
Entity Type:Individual
Prefix:
First Name:ONITA
Middle Name:VELMA
Last Name:FANGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ONITA
Other - Middle Name:VELMA
Other - Last Name:KAUFUSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 W 1900 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5530
Mailing Address - Country:US
Mailing Address - Phone:385-777-6587
Mailing Address - Fax:
Practice Address - Street 1:105 W 1900 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5530
Practice Address - Country:US
Practice Address - Phone:385-777-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTZ4J5H6Z8246RP1900X
390200000X
UT376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program