Provider Demographics
NPI:1447496047
Name:MENGA, GWENDOLINE NGANKEU (DO)
Entity type:Individual
Prefix:DR
First Name:GWENDOLINE
Middle Name:NGANKEU
Last Name:MENGA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17191 ST LUKES WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8047
Mailing Address - Country:US
Mailing Address - Phone:281-889-8957
Mailing Address - Fax:832-595-0308
Practice Address - Street 1:17191 ST LUKES WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8047
Practice Address - Country:US
Practice Address - Phone:281-889-8957
Practice Address - Fax:832-595-0308
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8040207RR0500X
LADO.000169207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333699202Medicaid
TX8FD753OtherBCBS
MS08532005Medicaid
TX333699201Medicaid
LA1944700Medicaid
TX333699202Medicaid
TX8FD753OtherBCBS
LA1944700Medicaid
TX262033ZPC0Medicare PIN