Provider Demographics
NPI:1942040324
Name:LENGANE, AICHA
Entity type:Individual
Prefix:
First Name:AICHA
Middle Name:
Last Name:LENGANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 WATERVIEW WAY APT L
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1279
Mailing Address - Country:US
Mailing Address - Phone:217-550-4967
Mailing Address - Fax:
Practice Address - Street 1:926 WATERVIEW WAY APT L
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1279
Practice Address - Country:US
Practice Address - Phone:217-550-4967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF122305363LF0000X, 363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily