Provider Demographics
NPI:1245651934
Name:KUNGANG, ROXANA ANU
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:ANU
Last Name:KUNGANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WESTVIEW TER
Mailing Address - Street 2:
Mailing Address - City:LITHOPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:43136-9713
Mailing Address - Country:US
Mailing Address - Phone:240-764-9919
Mailing Address - Fax:
Practice Address - Street 1:380 WESTVIEW TER
Practice Address - Street 2:
Practice Address - City:LITHOPOLIS
Practice Address - State:OH
Practice Address - Zip Code:43136-9713
Practice Address - Country:US
Practice Address - Phone:240-764-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OHRN.528830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251E00000XAgenciesHome Health