Provider Demographics
NPI:1386144061
Name:MAANGI, KEVIN ONSOMU (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ONSOMU
Last Name:MAANGI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 TANGLEWOOD LN APT 1705
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4807
Mailing Address - Country:US
Mailing Address - Phone:817-903-7470
Mailing Address - Fax:
Practice Address - Street 1:5050 TANGLEWOOD LN APT 1705
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-4807
Practice Address - Country:US
Practice Address - Phone:817-903-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX937454163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse