Provider Demographics
NPI:1922586627
Name:ABONGWA, ELVIS NWNEHBOM
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:NWNEHBOM
Last Name:ABONGWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5438 DUNSMORE HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5496
Mailing Address - Country:US
Mailing Address - Phone:419-450-6734
Mailing Address - Fax:
Practice Address - Street 1:5438 DUNSMORE HARBOR LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5496
Practice Address - Country:US
Practice Address - Phone:419-450-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26561164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse