Provider Demographics
NPI:1851857783
Name:KURIA, ANN MAMBO (NP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MAMBO
Last Name:KURIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 WOODLAND TRACE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6609
Mailing Address - Country:US
Mailing Address - Phone:901-497-7950
Mailing Address - Fax:
Practice Address - Street 1:6815 HILL CT
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-5513
Practice Address - Country:US
Practice Address - Phone:888-551-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002045363L00000X
CA95010693363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health