Provider Demographics
NPI:1770319691
Name:MONGO, TAMEKI LAVETTE (FNP)
Entity type:Individual
Prefix:DR
First Name:TAMEKI
Middle Name:LAVETTE
Last Name:MONGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 HUNTON FOREST DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0084
Mailing Address - Country:US
Mailing Address - Phone:704-491-3556
Mailing Address - Fax:
Practice Address - Street 1:12 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4537
Practice Address - Country:US
Practice Address - Phone:910-765-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily