Provider Demographics
NPI:1629610266
Name:LEBUGHE, RACHELLE NTANGE (OWNER)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:NTANGE
Last Name:LEBUGHE
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 CROSSCUT DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5630
Mailing Address - Country:US
Mailing Address - Phone:505-234-2699
Mailing Address - Fax:
Practice Address - Street 1:10411 CROSSCUT DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5630
Practice Address - Country:US
Practice Address - Phone:505-234-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide