Provider Demographics
NPI:1164082590
Name:AKIMANA, SOLANGE
Entity Type:Individual
Prefix:
First Name:SOLANGE
Middle Name:
Last Name:AKIMANA
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 1:9401 SALTBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7238
Mailing Address - Country:US
Mailing Address - Phone:817-724-7081
Mailing Address - Fax:
Practice Address - Street 1:9401 SALTBRUSH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-7238
Practice Address - Country:US
Practice Address - Phone:817-724-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX963231163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse