Provider Demographics
NPI:1922398676
Name:MAHENGA, GODFREY NEVISON (NURSE)
Entity Type:Individual
Prefix:
First Name:GODFREY
Middle Name:NEVISON
Last Name:MAHENGA
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 153RD ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5974
Mailing Address - Country:US
Mailing Address - Phone:347-239-4516
Mailing Address - Fax:
Practice Address - Street 1:9029 153RD ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5974
Practice Address - Country:US
Practice Address - Phone:347-239-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303340-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse