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NPI Code Detail

MEDICARE: LARISSA NGWE

MEDICARE: LARISSA NGWE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1119892TX

General Provider Information

NPI Number : 1033042114
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARISSA NGWE
Provider Business Mailing Address
First Line : 1110 S CESAR CHAVEZ BLVD APT 1002
Second Line :
City : DALLAS
State : TX
Zip : 75201-6063
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3500 GASTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75246-2017
Country : US
Telephone Number : 214-820-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ LARISSA NGWE ” Practice Location

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