Provider Demographics
NPI:1720364714
Name:NGOLO, TERENCE MINDAKO (LPN)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:MINDAKO
Last Name:NGOLO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 ISINGTON CT APT 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5019
Mailing Address - Country:US
Mailing Address - Phone:614-483-0935
Mailing Address - Fax:
Practice Address - Street 1:4586 ISINGTON CT APT 208
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5019
Practice Address - Country:US
Practice Address - Phone:614-483-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145220164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse