Provider Demographics
NPI:1184339368
Name:MBA, TOOCHUKWU ENDALINE
Entity type:Individual
Prefix:MRS
First Name:TOOCHUKWU
Middle Name:ENDALINE
Last Name:MBA
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 1:8712 BLUFFCREEK LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7285
Mailing Address - Country:US
Mailing Address - Phone:469-237-9776
Mailing Address - Fax:
Practice Address - Street 1:565 W OATES RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5463
Practice Address - Country:US
Practice Address - Phone:214-500-9844
Practice Address - Fax:972-908-9611
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily