Healthcare Provider Details

I. General information

NPI: 1013417963
Provider Name (Legal Business Name): ANNIE GISELE NGALET DJIOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 S US HIGHWAY 75
SHERMAN TX
75090-5707
US

IV. Provider business mailing address

3108 CANTURA DR
MESQUITE TX
75181-4671
US

V. Phone/Fax

Practice location:
  • Phone: 903-532-1400
  • Fax:
Mailing address:
  • Phone: 469-567-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number304510
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: