Provider Demographics
NPI:1245850973
Name:MGANGA, KEZIA
Entity type:Individual
Prefix:
First Name:KEZIA
Middle Name:
Last Name:MGANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PRESTBURY SQ STE 15
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2608
Mailing Address - Country:US
Mailing Address - Phone:302-533-6331
Mailing Address - Fax:
Practice Address - Street 1:200 N ANTLERS PL # 200
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2767
Practice Address - Country:US
Practice Address - Phone:469-438-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN230916163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse