Provider Demographics
NPI:1841802576
Name:DOUKOURE, MASSANDJE MAMA (RN)
Entity Type:Individual
Prefix:MS
First Name:MASSANDJE
Middle Name:MAMA
Last Name:DOUKOURE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 ROYAL LN APT 1148
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1110
Mailing Address - Country:US
Mailing Address - Phone:201-779-5310
Mailing Address - Fax:
Practice Address - Street 1:10075 ROYAL LN APT 1148
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1110
Practice Address - Country:US
Practice Address - Phone:201-779-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse