Provider Demographics
NPI:1770084345
Name:OMANGA, JOB NYANGENYA (LVN)
Entity type:Individual
Prefix:
First Name:JOB
Middle Name:NYANGENYA
Last Name:OMANGA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HERITAGE LN APT 103
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1902
Mailing Address - Country:US
Mailing Address - Phone:432-517-5374
Mailing Address - Fax:
Practice Address - Street 1:2224 N CARROLL BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1834
Practice Address - Country:US
Practice Address - Phone:432-517-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311609164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311609OtherTEXAS BOARD OF NURSING