Provider Demographics
NPI:1659822542
Name:LIKEMBI, NDONGO (AANP)
Entity type:Individual
Prefix:
First Name:NDONGO
Middle Name:
Last Name:LIKEMBI
Suffix:
Gender:M
Credentials:AANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 HIGHWAY 72 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9564
Mailing Address - Country:US
Mailing Address - Phone:256-837-2271
Mailing Address - Fax:256-837-2910
Practice Address - Street 1:8045 HIGHWAY 72 W
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9564
Practice Address - Country:US
Practice Address - Phone:256-837-2271
Practice Address - Fax:256-837-2910
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-127063OtherAL BOARD OF NURSING