Provider Demographics
NPI:1376942391
Name:MANGA, CATHERINE NANYONGO (FNPBC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:NANYONGO
Last Name:MANGA
Suffix:
Gender:F
Credentials:FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25711 CANYON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5291
Mailing Address - Country:US
Mailing Address - Phone:832-439-7386
Mailing Address - Fax:
Practice Address - Street 1:18400 KATY FWY STE 570
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1291
Practice Address - Country:US
Practice Address - Phone:713-722-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily