Healthcare Provider Details

I. General information

NPI: 1740066760
Provider Name (Legal Business Name): HELEN TEMA-NGEFORF FOKUNANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 S 500 W
LOGAN UT
84321-5165
US

IV. Provider business mailing address

547 S 500 W
LOGAN UT
84321-5165
US

V. Phone/Fax

Practice location:
  • Phone: 248-797-0583
  • Fax:
Mailing address:
  • Phone: 248-797-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78326
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1028966-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: