Provider Demographics
NPI:1023733268
Name:ONGERA, REBECCA KEMUNTO (NURSE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KEMUNTO
Last Name:ONGERA
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 E MAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3215
Mailing Address - Country:US
Mailing Address - Phone:419-378-1339
Mailing Address - Fax:
Practice Address - Street 1:2567 E SAN FELIPE TRL
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-5012
Practice Address - Country:US
Practice Address - Phone:419-378-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN280719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN280719Medicaid