Provider Demographics
NPI:1376734335
Name:MWONGA, REBECCA ANYOSO (RN, BSN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANYOSO
Last Name:MWONGA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 CAVALCADE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7126
Mailing Address - Country:US
Mailing Address - Phone:817-803-5884
Mailing Address - Fax:469-520-5801
Practice Address - Street 1:1118 CAVALCADE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:817-803-5884
Practice Address - Fax:469-520-5801
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704828163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator