Provider Demographics
NPI:1396245015
Name:NJINDONG, SAMUEL NJINDONG (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:NJINDONG
Last Name:NJINDONG
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:NJINDONG
Other - Last Name:NJINDONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5801 OAKMERE LN
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1916
Mailing Address - Country:US
Mailing Address - Phone:214-994-2970
Mailing Address - Fax:
Practice Address - Street 1:5801 OAKMERE LN
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1916
Practice Address - Country:US
Practice Address - Phone:214-994-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335729164W00000X
TX1041196163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse