Provider Demographics
NPI:1245104843
Name:KPAGA, SALOME AYISA (RN)
Entity type:Individual
Prefix:
First Name:SALOME
Middle Name:AYISA
Last Name:KPAGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E 206TH ST APT 39
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4082
Mailing Address - Country:US
Mailing Address - Phone:929-426-9148
Mailing Address - Fax:
Practice Address - Street 1:327 E 206TH ST APT 39
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4082
Practice Address - Country:US
Practice Address - Phone:929-426-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY840438-01163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice