Doctor Name: | JACKLINE NANGA |
NPI Number: | 1043615099 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN FNP-BC |
License Number: | LG- 0000795 |
Business Practice Address: | 106 Bow St Elkton, MD - 219215544 |
Business Phone Number: | 4103984000 |
Business Fax Number: | |
Mailing Address: | 106 Bow St, ELKTON |
State: | MD |
Postal Code: | 219215544 |
Phone Number: | 4103984000 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2014 |
NPI Last Update Date: | 11/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | LG- 0000795 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DE |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |