Provider Demographics
NPI:1972018364
Name:NAENGE, PAUL AGBOR (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AGBOR
Last Name:NAENGE
Suffix:
Gender:M
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 HAMILTON CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1632 HAMILTON CT
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4757
Practice Address - Country:US
Practice Address - Phone:405-408-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008309363LF0000X
GARN234959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95008309OtherSTATE MEDICAL LICENSE
FLAPRN11018999OtherSTATE MEDICAL LICENSE
MO2023021736OtherSTATE MEDICAL LICENSE
KS82362OtherSTATE MEDICAL LICENSE