Provider Demographics
NPI:1144720855
Name:NGWINGALAH, GRACE FORMUKONG (RN)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:FORMUKONG
Last Name:NGWINGALAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 BUCKINGHAM RD APT 1133
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5688
Mailing Address - Country:US
Mailing Address - Phone:469-531-4594
Mailing Address - Fax:
Practice Address - Street 1:540 BUCKINGHAM RD APT 1133
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5688
Practice Address - Country:US
Practice Address - Phone:469-531-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX925465163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse