Active NPI
Bokeng Isange Nwengela
- Family Nurse Practitioner
- Carson, CA
National Provider Identifier
1134737356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95013227
- Practice address
- 2637 E Carson St
Carson, CA 90810-1508 - Phone
- (310) 933-6450
- NPI assigned
- Jul 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95013227 | CA | Primary |
Addresses
Primary practice location
2637 E Carson St
Carson, CA 90810-1508
Mailing address
16761 Viewpoint LN Apt 80
Huntington Beach, CA 92647-4758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220810002757 | CA | Order and Referring Only - Nurse Practitioner | 8022491984 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95013227 | CA | MD | Family Nurse Practitioner |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594684800000",
"number": "1134737356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16761 VIEWPOINT LN APT 80",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926474758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2637 E CARSON ST",
"city": "CARSON",
"state": "CA",
"postal_code": "908101508",
"telephone_number": "310-933-6450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NWENGELA",
"first_name": "BOKENG",
"middle_name": "ISANGE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-14",
"last_updated": "2020-07-14",
"certification_date": "2020-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95013227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.