Provider Demographics
NPI:1538534300
Name:NGWAINBI, ELSIE NGANG
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:NGANG
Last Name:NGWAINBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:
Other - Last Name:TAMBOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1605 HUNTWOOD PARK CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3998
Mailing Address - Country:US
Mailing Address - Phone:313-354-1343
Mailing Address - Fax:
Practice Address - Street 1:50505 SCHOENHERR RD STE 340
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-731-8400
Practice Address - Fax:586-731-8406
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281807163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse