Provider Demographics
NPI:1982019626
Name:MUANGE-KAMBUMBA, GRACE (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MUANGE-KAMBUMBA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:TSHIMANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:382 LAKE WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5760
Mailing Address - Country:US
Mailing Address - Phone:503-875-1956
Mailing Address - Fax:
Practice Address - Street 1:1300 DACY LN STE 140
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4195
Practice Address - Country:US
Practice Address - Phone:512-871-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner