Provider Demographics
NPI:1649533118
Name:NKENG, CATHERINE AGANG
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:AGANG
Last Name:NKENG
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 1:60 LOVERS LEAP AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2857
Mailing Address - Country:US
Mailing Address - Phone:978-429-5915
Mailing Address - Fax:
Practice Address - Street 1:60 LOVERS LEAP AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2857
Practice Address - Country:US
Practice Address - Phone:978-429-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89038164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse