Provider Demographics
NPI:1740988823
Name:NGONG, LESLIE SUIPE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:SUIPE
Last Name:NGONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 LAKESIDE DR APT 202G
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7737
Mailing Address - Country:US
Mailing Address - Phone:513-883-3158
Mailing Address - Fax:
Practice Address - Street 1:6642 LAKESIDE DR APT 202G
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7737
Practice Address - Country:US
Practice Address - Phone:513-883-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker