Healthcare Provider Details

I. General information

NPI: 1083382311
Provider Name (Legal Business Name): LAETITIA SORELA NJOME TCHAPTCHET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 UNIVERSITY BLVD
TYLER TX
75799-6600
US

IV. Provider business mailing address

2114 WASHINGTON CIR ARLINGTON
ARLINGTON TX
76011
US

V. Phone/Fax

Practice location:
  • Phone: 432-210-0820
  • Fax:
Mailing address:
  • Phone: 432-210-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: