Provider Demographics
NPI:1114376613
Name:NSUBUGA, JULIETTE
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:NSUBUGA
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 1:825 S CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3663
Mailing Address - Country:US
Mailing Address - Phone:817-449-9340
Mailing Address - Fax:214-333-7342
Practice Address - Street 1:825 S CROWLEY RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3663
Practice Address - Country:US
Practice Address - Phone:817-449-9340
Practice Address - Fax:817-297-3153
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily