Provider Demographics
NPI:1366221277
Name:NKIMBENG, ANYE
Entity type:Individual
Prefix:
First Name:ANYE
Middle Name:
Last Name:NKIMBENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERRIMACK ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1707
Mailing Address - Country:US
Mailing Address - Phone:978-455-0756
Mailing Address - Fax:
Practice Address - Street 1:300 MERRIMACK ST STE 205
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-5905
Practice Address - Country:US
Practice Address - Phone:978-455-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker