Provider Demographics
NPI:1912884784
Name:MENDY, NDAMBOU
Entity type:Individual
Prefix:MR
First Name:NDAMBOU
Middle Name:
Last Name:MENDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NYIMA
Other - Middle Name:
Other - Last Name:GIBBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:N1145 GLENNVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8782
Mailing Address - Country:US
Mailing Address - Phone:920-489-4771
Mailing Address - Fax:
Practice Address - Street 1:4475 SODA CREEK RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1025
Practice Address - Country:US
Practice Address - Phone:920-489-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility