Provider Demographics
NPI:1760723209
Name:NANA, HEDRINE MANDE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:HEDRINE
Middle Name:MANDE
Last Name:NANA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167342
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-7342
Mailing Address - Country:US
Mailing Address - Phone:469-628-4247
Mailing Address - Fax:
Practice Address - Street 1:601 N INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5234
Practice Address - Country:US
Practice Address - Phone:817-283-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX754156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily