Provider Demographics
NPI:1942716444
Name:NGWA, WILLIAM FONCHAM (FNP-PMHNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FONCHAM
Last Name:NGWA
Suffix:
Gender:M
Credentials:FNP-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LIBERTY PL
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5708
Mailing Address - Country:US
Mailing Address - Phone:856-981-2891
Mailing Address - Fax:
Practice Address - Street 1:1100 LIBERTY PL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5708
Practice Address - Country:US
Practice Address - Phone:856-981-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001203363LF0000X
NJ26NJ00769100363LF0000X, 363LP0808X
DEL8-0010811363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1U9122Medicaid
DE1U9122Medicaid
DEMN5211901OtherDEA