Provider Demographics
NPI:1881195337
Name:KINYANJUI, SUSAN NYAMBURA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NYAMBURA
Last Name:KINYANJUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 E US HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8622
Mailing Address - Country:US
Mailing Address - Phone:972-231-3552
Mailing Address - Fax:
Practice Address - Street 1:775 E US HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8622
Practice Address - Country:US
Practice Address - Phone:972-552-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP146164363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily