Provider Demographics
NPI:1083119242
Name:MWANGALA, EUNICE DUMONGO (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:DUMONGO
Last Name:MWANGALA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 S CUSTER RD APT 2402
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6224
Mailing Address - Country:US
Mailing Address - Phone:919-949-1153
Mailing Address - Fax:
Practice Address - Street 1:2305 S CUSTER RD APT 2402
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6224
Practice Address - Country:US
Practice Address - Phone:919-949-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX929366163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty