Provider Demographics
NPI:1801118310
Name:NKEMNKENG, STELLA NGULEFAC
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:NGULEFAC
Last Name:NKEMNKENG
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 1:3040 EAST MAIN STREET,
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2644
Mailing Address - Country:US
Mailing Address - Phone:614-725-0336
Mailing Address - Fax:
Practice Address - Street 1:3040 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2644
Practice Address - Country:US
Practice Address - Phone:614-725-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 130657164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse