Provider Demographics
NPI:1699218636
Name:NGOZI MANACK, NATACHA LAURE
Entity type:Individual
Prefix:
First Name:NATACHA LAURE
Middle Name:
Last Name:NGOZI MANACK
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 1:9118 SYMPHONIC LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-2469
Mailing Address - Country:US
Mailing Address - Phone:318-243-1055
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:9118 SYMPHONIC LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-2469
Practice Address - Country:US
Practice Address - Phone:318-243-1055
Practice Address - Fax:701-857-5031
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132430363LF0000X
NDR43934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily