Provider Demographics
NPI:1164024949
Name:NYAGETIRIA, MILLICENT WAMBOI (LVN)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:WAMBOI
Last Name:NYAGETIRIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MILLICENT
Other - Middle Name:WAMBOI
Other - Last Name:NYAGETIRIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1907 TAMPA BAY WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4022
Mailing Address - Country:US
Mailing Address - Phone:682-559-6499
Mailing Address - Fax:
Practice Address - Street 1:1907 TAMPA BAY WAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4022
Practice Address - Country:US
Practice Address - Phone:682-559-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304532164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse