Provider Demographics
NPI:1750896098
Name:HANSENDE, CHOMBA (FNP-C)
Entity type:Individual
Prefix:
First Name:CHOMBA
Middle Name:
Last Name:HANSENDE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 ROBINSON JEFFERSON DR APT 408
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7271
Mailing Address - Country:US
Mailing Address - Phone:903-372-3660
Mailing Address - Fax:
Practice Address - Street 1:1608 GAYLA CREEK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-4992
Practice Address - Country:US
Practice Address - Phone:903-372-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135941363LF0000X
MDR233439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily