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NPI Code Detail

MEDICARE: PURITY MBURU

MEDICARE: PURITY MBURU
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1167001TX
2163W00000XRegistered Nurse950102TX

General Provider Information

NPI Number : 1992282818
Entity Type Code : Individual
Provider Name (Legal Business Name) : PURITY MBURU
Provider Business Mailing Address
First Line : 1305 THICKET DR
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-6424
Country : US
Telephone Number : 682-410-5943
Fax Number :
Provider Business Practice Location Address
First Line : 325 N SAINT PAUL ST STE 3100
Second Line :
City : DALLAS
State : TX
Zip : 75201-3923
Country : US
Telephone Number : 469-905-4375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2018
Last Update Date : 05/29/2026

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Directions to “ PURITY MBURU ” Practice Location

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