Provider Demographics
NPI:1295440121
Name:MAKIA-NFONOYIM, PETRA BONGSIYSI
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:BONGSIYSI
Last Name:MAKIA-NFONOYIM
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 1:5123 ROYAL SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2891
Mailing Address - Country:US
Mailing Address - Phone:405-371-8263
Mailing Address - Fax:
Practice Address - Street 1:5123 ROYAL SUNSET CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2891
Practice Address - Country:US
Practice Address - Phone:405-371-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068823363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care