Provider Demographics
NPI:1760196646
Name:CHUNOW, BELTHA NJANJE
Entity Type:Individual
Prefix:
First Name:BELTHA
Middle Name:NJANJE
Last Name:CHUNOW
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 1:2615 COUNTRY GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5002
Mailing Address - Country:US
Mailing Address - Phone:256-468-3853
Mailing Address - Fax:
Practice Address - Street 1:2615 COUNTRY GROVE TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5002
Practice Address - Country:US
Practice Address - Phone:256-468-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099440363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health