Provider Demographics
NPI:1073071551
Name:NDUKA, NDUKA
Entity Type:Individual
Prefix:
First Name:NDUKA
Middle Name:
Last Name:NDUKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 WYNFORD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7655
Mailing Address - Country:US
Mailing Address - Phone:469-348-6910
Mailing Address - Fax:
Practice Address - Street 1:4013 WYNFORD DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-7655
Practice Address - Country:US
Practice Address - Phone:469-348-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)