MEDICARE: ELIZABETH ESTHER MUGWANYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	331267	TX

General Provider Information

NPI Number	:	1497234520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ESTHER MUGWANYA

Provider Business Mailing Address
First Line	:	5212 NOVATO PL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6223
Country	:	US
Telephone Number	:	661-755-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 NOVATO PL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6223
Country	:	US
Telephone Number	:	661-755-8847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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