Provider Demographics
NPI:1982312351
Name:GONWAY, PRINCE YAN QUOIBIA
Entity Type:Individual
Prefix:
First Name:PRINCE
Middle Name:YAN QUOIBIA
Last Name:GONWAY
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 1:4408 AIRPORT HWY APT 23
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7084
Mailing Address - Country:US
Mailing Address - Phone:419-386-8000
Mailing Address - Fax:
Practice Address - Street 1:4408 AIRPORT HWY APT 23
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7084
Practice Address - Country:US
Practice Address - Phone:419-386-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist