Provider Demographics
NPI:1467798397
Name:NFORMANGUM, CATHARINE (NP)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:
Last Name:NFORMANGUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 FM 1765 STE C-102
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-3689
Mailing Address - Country:US
Mailing Address - Phone:409-995-0765
Mailing Address - Fax:409-995-0823
Practice Address - Street 1:8030 FM 1765 STE C-102
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3689
Practice Address - Country:US
Practice Address - Phone:409-995-0765
Practice Address - Fax:409-995-0823
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily