Provider Demographics
NPI:1881188969
Name:NYAMAMBA, ALEX SAKAGWA
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:SAKAGWA
Last Name:NYAMAMBA
Suffix:
Gender:M
Credentials:
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 740222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-0222
Mailing Address - Country:US
Mailing Address - Phone:714-224-6144
Mailing Address - Fax:
Practice Address - Street 1:1710 VALLEY VIEW LN APT 2033
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-3529
Practice Address - Country:US
Practice Address - Phone:214-429-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306919164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse