Provider Demographics
NPI:1164224887
Name:MNGOMEZULU, NOMZAMO GUGU
Entity type:Individual
Prefix:MRS
First Name:NOMZAMO
Middle Name:GUGU
Last Name:MNGOMEZULU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N MAIN ST # 206
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2656
Mailing Address - Country:US
Mailing Address - Phone:203-590-1214
Mailing Address - Fax:
Practice Address - Street 1:20 N MAIN ST # 206
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2656
Practice Address - Country:US
Practice Address - Phone:203-590-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0002553376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker