Provider Demographics
NPI:1659611986
Name:BONGO, CALECHE NJWENG (BSC, LVN)
Entity Type:Individual
Prefix:MISS
First Name:CALECHE
Middle Name:NJWENG
Last Name:BONGO
Suffix:
Gender:F
Credentials:BSC, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S RAMBLING RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3535
Mailing Address - Country:US
Mailing Address - Phone:240-425-2240
Mailing Address - Fax:
Practice Address - Street 1:51 S RAMBLING RIDGE PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77385-3535
Practice Address - Country:US
Practice Address - Phone:240-425-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309778164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse