Provider Demographics
NPI:1295380798
Name:MUKETE, EMILIA IYA MASEKI
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:IYA MASEKI
Last Name:MUKETE
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 1:13113 LARKS VIEW PT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-1819
Mailing Address - Country:US
Mailing Address - Phone:682-554-8846
Mailing Address - Fax:
Practice Address - Street 1:13113 LARKS VIEW PT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-1819
Practice Address - Country:US
Practice Address - Phone:682-554-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327200164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse