Provider Demographics
NPI:1689458119
Name:ONGWAE, PHELISTER BONARERI (MBA, BSN, RN)
Entity Type:Individual
Prefix:
First Name:PHELISTER
Middle Name:BONARERI
Last Name:ONGWAE
Suffix:
Gender:F
Credentials:MBA, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BEAUDOIN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6700
Mailing Address - Country:US
Mailing Address - Phone:603-203-1340
Mailing Address - Fax:
Practice Address - Street 1:6 BEAUDOIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6700
Practice Address - Country:US
Practice Address - Phone:603-203-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053680-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse