Provider Demographics
NPI:1508226259
Name:MUKETE, TINA F (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:F
Last Name:MUKETE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:F
Other - Last Name:EBANJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5129 N BRYAN RD
Mailing Address - Street 2:2
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573-4252
Mailing Address - Country:US
Mailing Address - Phone:281-912-8747
Mailing Address - Fax:
Practice Address - Street 1:5129 N BRYAN RD
Practice Address - Street 2:2
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-4252
Practice Address - Country:US
Practice Address - Phone:281-912-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor