Provider Demographics
NPI:1598407637
Name:MFINANGA, SAMUEL CALEB
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CALEB
Last Name:MFINANGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1338
Mailing Address - Country:US
Mailing Address - Phone:402-802-0974
Mailing Address - Fax:
Practice Address - Street 1:5530 LA SALLE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1338
Practice Address - Country:US
Practice Address - Phone:402-802-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer