Provider Demographics
NPI:1568191252
Name:MBANG, LINDA SEVIDZEM (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SEVIDZEM
Last Name:MBANG
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 NORTHPARK DR # 1031
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1744
Mailing Address - Country:US
Mailing Address - Phone:281-503-4673
Mailing Address - Fax:
Practice Address - Street 1:21311 TREBUCHET DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-503-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096937363LP0808X
TX886256163W00000X
AZ279587363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse