Provider Demographics
NPI:1932507944
Name:MWANYALO, JESILINAH MANGA
Entity Type:Individual
Prefix:MISS
First Name:JESILINAH
Middle Name:MANGA
Last Name:MWANYALO
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 1:200 N I 35 STE E
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-4301
Mailing Address - Country:US
Mailing Address - Phone:469-807-3177
Mailing Address - Fax:469-807-3179
Practice Address - Street 1:200 N I 35 STE E
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4301
Practice Address - Country:US
Practice Address - Phone:469-807-3177
Practice Address - Fax:469-807-3179
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily