Provider Demographics
NPI:1669155123
Name:NYAMONGO, JANICE GACHERI (FNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:GACHERI
Last Name:NYAMONGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:GACHERI
Other - Last Name:NCEENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4345 JOHN B OBLINGER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3797
Mailing Address - Country:US
Mailing Address - Phone:915-801-8080
Mailing Address - Fax:
Practice Address - Street 1:4345 JOHN B OBLINGER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3797
Practice Address - Country:US
Practice Address - Phone:915-801-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily