Provider Demographics
NPI:1023591542
Name:KASTO, MAGGIE ABWO I
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ABWO
Last Name:KASTO
Suffix:I
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 1:6864 LARMANDA ST APT 276
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0202
Mailing Address - Country:US
Mailing Address - Phone:214-962-8023
Mailing Address - Fax:
Practice Address - Street 1:6864 LARMANDA ST APT 276
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0202
Practice Address - Country:US
Practice Address - Phone:214-962-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342629164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse