Provider Demographics
NPI:1528696416
Name:TALLA AYUK MANYANG, RFANYU DAISY
Entity type:Individual
Prefix:
First Name:RFANYU
Middle Name:DAISY
Last Name:TALLA AYUK MANYANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 CASTLE GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1739
Mailing Address - Country:US
Mailing Address - Phone:832-406-5720
Mailing Address - Fax:
Practice Address - Street 1:2111 CASTLE GARDENS LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1739
Practice Address - Country:US
Practice Address - Phone:832-406-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX890474163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency