Provider Demographics
NPI:1801192034
Name:ATENCHONG, NKENDEM (LPN)
Entity Type:Individual
Prefix:MR
First Name:NKENDEM
Middle Name:
Last Name:ATENCHONG
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 1:1120 LORING RD APT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-5111
Mailing Address - Country:US
Mailing Address - Phone:614-432-7112
Mailing Address - Fax:
Practice Address - Street 1:1120 LORING RD APT C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-5111
Practice Address - Country:US
Practice Address - Phone:614-432-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142982164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse