Provider Demographics
NPI:1497232144
Name:OMANGA, DAMARIS (LVN)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:OMANGA
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 1:14231 FENTON LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2293
Mailing Address - Country:US
Mailing Address - Phone:832-614-8260
Mailing Address - Fax:
Practice Address - Street 1:14231 FENTON LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2293
Practice Address - Country:US
Practice Address - Phone:832-614-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179633164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13044263OtherHOME HEALTHCARE