Provider Demographics
NPI:1619512340
Name:NGWA NGU, CHARLOTTE LUM
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LUM
Last Name:NGWA NGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21727 ANDREWS GDN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7583
Mailing Address - Country:US
Mailing Address - Phone:469-230-1239
Mailing Address - Fax:
Practice Address - Street 1:21727 ANDREWS GDN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7583
Practice Address - Country:US
Practice Address - Phone:469-230-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX895681163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse