Provider Demographics
NPI:1639793722
Name:NKEMBENG, PRISCO A (MBBS, MPH, RN)
Entity Type:Individual
Prefix:DR
First Name:PRISCO
Middle Name:A
Last Name:NKEMBENG
Suffix:
Gender:M
Credentials:MBBS, MPH, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ANGEL AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-2567
Mailing Address - Country:US
Mailing Address - Phone:781-475-6365
Mailing Address - Fax:
Practice Address - Street 1:5 ANGEL AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-2567
Practice Address - Country:US
Practice Address - Phone:781-475-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 251E00000X
MARN2306433163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No163WH0200XNursing Service ProvidersRegistered NurseHome Health