Provider Demographics
NPI:1740763432
Name:MAANGI, TERESIA MWANGO (LVN)
Entity Type:Individual
Prefix:MRS
First Name:TERESIA
Middle Name:MWANGO
Last Name:MAANGI
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 1:2415 CARSON TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7865
Mailing Address - Country:US
Mailing Address - Phone:817-602-0174
Mailing Address - Fax:
Practice Address - Street 1:2415 CARSON TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7865
Practice Address - Country:US
Practice Address - Phone:817-602-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse