Provider Demographics
NPI:1740066760
Name:FOKUNANG, HELEN TEMA-NGEFORF (NP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:TEMA-NGEFORF
Last Name:FOKUNANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 S 500 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5165
Mailing Address - Country:US
Mailing Address - Phone:248-797-0583
Mailing Address - Fax:
Practice Address - Street 1:547 S 500 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5165
Practice Address - Country:US
Practice Address - Phone:248-797-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78326363LF0000X
UT1028966-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily