Doctor Name: | NSULU MANDIANGU |
NPI Number: | 1043511553 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | R.N. |
License Number: | 741609 |
Business Practice Address: | 15712 Crestwood Dr Apt 426 San Pablo, CA - 948065626 |
Business Phone Number: | 5107586851 |
Business Fax Number: | |
Mailing Address: | 15712 Crestwood Dr Apt 426, SAN PABLO |
State: | CA |
Postal Code: | 948065626 |
Phone Number: | 5107586851 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2010 |
NPI Last Update Date: | 11/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WH0200X |
License Number: | 741609 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Home Health |
Taxonomy Definition: |