1194427872 NPI number — MARTHA LUMNGWEGANG ESEH NP

Table of content: (NPI 1326654369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194427872 NPI number — MARTHA LUMNGWEGANG ESEH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESEH
Provider First Name:
MARTHA
Provider Middle Name:
LUMNGWEGANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIBBS
Provider Other First Name:
MARTHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194427872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 ARNOLD PALMER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADVANCE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27006-7310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2554 LEWISVILLE CLEMMONS RD STE 305K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEMMONS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27012-8110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-283-7140
Provider Business Practice Location Address Fax Number:
866-543-9146
Provider Enumeration Date:
03/20/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  ESEH-Q3N09 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 5017881 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)