Provider Demographics
NPI:1396215356
Name:WANGUKU, PURITY WANJIKU
Entity Type:Individual
Prefix:MISS
First Name:PURITY
Middle Name:WANJIKU
Last Name:WANGUKU
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 1:617 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3718
Mailing Address - Country:US
Mailing Address - Phone:214-682-4534
Mailing Address - Fax:
Practice Address - Street 1:26795 US HIGHWAY 380 E
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-7853
Practice Address - Country:US
Practice Address - Phone:972-347-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily