Provider Demographics
NPI:1467906420
Name:ATABONG, FELIX (LPN)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:ATABONG
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 CHAGRIN RD STE 135
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1136
Mailing Address - Country:US
Mailing Address - Phone:440-318-1000
Mailing Address - Fax:440-318-1092
Practice Address - Street 1:7160 CHAGRIN RD STE 135
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-1136
Practice Address - Country:US
Practice Address - Phone:440-318-1000
Practice Address - Fax:440-318-1092
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376K00000X
OH152595164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide