Provider Demographics
NPI:1538908850
Name:NTANANGA, ALLEN (LPN)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:NTANANGA
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 1:21 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-3112
Mailing Address - Country:US
Mailing Address - Phone:781-726-2784
Mailing Address - Fax:
Practice Address - Street 1:21 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-3112
Practice Address - Country:US
Practice Address - Phone:781-726-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN67276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse