Provider Demographics
NPI:1497042188
Name:NDISANG, ELIZABETH WANYAM (CNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WANYAM
Last Name:NDISANG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 W EL SEGUNDO BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1722
Mailing Address - Country:US
Mailing Address - Phone:310-227-1760
Mailing Address - Fax:
Practice Address - Street 1:2114 W EL SEGUNDO BLVD APT 1
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-1722
Practice Address - Country:US
Practice Address - Phone:310-227-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00198671374U00000X
CA00641181376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide