Individual
MISS MANJERNGIE CECELIA NDEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, PHD
Contact information
Practice address
451 W. MILHAM AVE, PORTAGE, MI 49024
(269) 488-9008
(269) 488-9001
Mailing address
P.O. BOX 497, PORTAGE, MI 49081
(269) 488-9008
(269) 488-9001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704241860
MI
363LP2300X
Primary Care Nurse Practitioner
4704241860
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12016777
BCBSM
MI
Enumeration date
01/10/2007
Last updated
11/06/2017
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