Healthcare Provider Details

I. General information

NPI: 1902300965
Provider Name (Legal Business Name): MONALISA KAMBANJE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E LAMAR BLVD
ARLINGTON TX
76011
US

IV. Provider business mailing address

1301 W PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75080-1135
US

V. Phone/Fax

Practice location:
  • Phone: 682-236-5770
  • Fax:
Mailing address:
  • Phone: 469-332-7925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP135158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: