Provider Demographics
NPI:1275092694
Name:NXUMALO, NONKULULEKO DOREEN
Entity Type:Individual
Prefix:
First Name:NONKULULEKO
Middle Name:DOREEN
Last Name:NXUMALO
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 1:210 E BROWNING ST
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-0540
Mailing Address - Country:US
Mailing Address - Phone:408-833-9984
Mailing Address - Fax:
Practice Address - Street 1:210 E BROWNING ST
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-0540
Practice Address - Country:US
Practice Address - Phone:408-833-9984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324893164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse