Provider Demographics
NPI:1902110943
Name:NKONDEM, PRUDENCIA NCHONGANYI (LPN)
Entity Type:Individual
Prefix:
First Name:PRUDENCIA
Middle Name:NCHONGANYI
Last Name:NKONDEM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 WALFORD ST
Mailing Address - Street 2:APT. B1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1474
Mailing Address - Country:US
Mailing Address - Phone:614-516-3361
Mailing Address - Fax:
Practice Address - Street 1:4349 WALFORD ST
Practice Address - Street 2:APT. B1
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1474
Practice Address - Country:US
Practice Address - Phone:614-516-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140444.M.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse