Provider Demographics
NPI:1437910700
Name:NGANGA, KATHLEEN MARIE ROSE (STNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE ROSE
Last Name:NGANGA
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34826 LAKE SHORE BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2024
Mailing Address - Country:US
Mailing Address - Phone:216-389-8448
Mailing Address - Fax:
Practice Address - Street 1:34826 LAKE SHORE BLVD APT C
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2024
Practice Address - Country:US
Practice Address - Phone:216-389-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty