Provider Demographics
NPI:1124834957
Name:DEWELE, METASEBIYA KUCHA (FNP-BC)
Entity type:Individual
Prefix:
First Name:METASEBIYA
Middle Name:KUCHA
Last Name:DEWELE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 THORNHILL WAY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-6051
Mailing Address - Country:US
Mailing Address - Phone:469-363-0429
Mailing Address - Fax:
Practice Address - Street 1:3714 THORNHILL WAY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-6051
Practice Address - Country:US
Practice Address - Phone:469-363-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily