Provider Demographics
NPI:1902239213
Name:FLORENCE JINGWA MBEKEMTANJONG
Entity Type:Organization
Organization Name:FLORENCE JINGWA MBEKEMTANJONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:JINGWA
Authorized Official - Last Name:MBEKEMTANJONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-209-0250
Mailing Address - Street 1:1609 DREAM CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1576
Mailing Address - Country:US
Mailing Address - Phone:614-209-0250
Mailing Address - Fax:
Practice Address - Street 1:1609 DREAM CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1576
Practice Address - Country:US
Practice Address - Phone:614-209-0250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-117004-MEDS251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care