Provider Demographics
NPI:1437791852
Name:MOMBEFOR, BERNICE (LVN)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:MOMBEFOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 PURPLEMARTIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6866
Mailing Address - Country:US
Mailing Address - Phone:469-777-2149
Mailing Address - Fax:713-999-9131
Practice Address - Street 1:13838 PURPLEMARTIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6866
Practice Address - Country:US
Practice Address - Phone:469-777-2149
Practice Address - Fax:713-999-9131
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324630164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse