Provider Demographics
NPI:1477059368
Name:NKWENTI- NECKMEN, VALERY
Entity Type:Individual
Prefix:
First Name:VALERY
Middle Name:
Last Name:NKWENTI- NECKMEN
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 1:109 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8645
Mailing Address - Country:US
Mailing Address - Phone:214-683-1987
Mailing Address - Fax:
Practice Address - Street 1:109 AUTUMNWOOD DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8645
Practice Address - Country:US
Practice Address - Phone:214-683-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-01
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217994164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty