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General NPI Number Information
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NPI Number | 1194303164
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Entity Type | Individual
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Provider Name | IRENE MUGO
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 1150 WHITLEY RD
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City | KELLER
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State | TX
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Zip | 76248-3038
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Country | US
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Telephone | 817-431-2518
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Fax |
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Provider Business Mailing Address
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Address Line | 13225 SETTLERS TRL
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City | FORT WORTH
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State | TX
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Zip | 76244-5706
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Country | US
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Telephone | 919-384-5393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | NA0060050642
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License Number State | TX
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