Healthcare Provider Details

I. General information

NPI: 1396245015
Provider Name (Legal Business Name): SAMUEL NJINDONG NJINDONG REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMUEL NJINDONG NJINDONG REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 OAKMERE LN
AUBREY TX
76227-1916
US

IV. Provider business mailing address

5801 OAKMERE LN
AUBREY TX
76227-1916
US

V. Phone/Fax

Practice location:
  • Phone: 214-994-2970
  • Fax:
Mailing address:
  • Phone: 214-994-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number335729
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1041196
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: