Provider Demographics
NPI:1093332975
Name:AKWANGA, RELINDIS MANA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:RELINDIS
Middle Name:MANA
Last Name:AKWANGA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:RELINDIS
Other - Middle Name:MANA
Other - Last Name:TEBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 N FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5306
Mailing Address - Country:US
Mailing Address - Phone:505-863-3120
Mailing Address - Fax:505-863-2961
Practice Address - Street 1:610 N FIFTH ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5306
Practice Address - Country:US
Practice Address - Phone:505-863-3120
Practice Address - Fax:505-863-2961
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily