Provider Demographics
NPI:1821679051
Name:SIKAZWE, FUKAMANJI (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:FUKAMANJI
Middle Name:
Last Name:SIKAZWE
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3196
Mailing Address - Country:US
Mailing Address - Phone:432-212-7148
Mailing Address - Fax:
Practice Address - Street 1:5813 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5055
Practice Address - Country:US
Practice Address - Phone:432-570-0052
Practice Address - Fax:432-570-0053
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1033659OtherLICENSE