Provider Demographics
NPI:1578039178
Name:NKPANAM, MARY ASUQUO (REGISTERED NURSE RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ASUQUO
Last Name:NKPANAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ASUQUO
Other - Last Name:BASSAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 JACKSON SQUARE DR APT 216
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6303
Mailing Address - Country:US
Mailing Address - Phone:817-343-9390
Mailing Address - Fax:
Practice Address - Street 1:609 JACKSON SQUARE DR APT 216
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6303
Practice Address - Country:US
Practice Address - Phone:817-343-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX952750163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse