MEDICARE: FAVOUR GRACE NGANJE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	155987	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3049418	OTHER	OH	MEDICARE, INDEPENDENT PROVIDER

General Provider Information

NPI Number	:	1427468040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAVOUR GRACE NGANJE

Provider Business Mailing Address
First Line	:	4076 ELAINE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-5602
Country	:	US
Telephone Number	:	614-735-1746
Fax Number	:

Provider Business Practice Location Address
First Line	:	4076 ELAINE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-5602
Country	:	US
Telephone Number	:	614-735-1746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	09/25/2014

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Directions to “ FAVOUR GRACE NGANJE ” Practice Location

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