MEDICARE: SIMINIBE MONEKE NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	AP135271	TX

General Provider Information

NPI Number	:	1861902934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMINIBE MONEKE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	111 EXECUTIVE WAY STE 102
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2388
Country	:	US
Telephone Number	:	469-941-4029
Fax Number	:	866-803-8759

Provider Business Practice Location Address
First Line	:	111 EXECUTIVE WAY STE 102
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2388
Country	:	US
Telephone Number	:	469-941-4029
Fax Number	:	866-803-8759

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

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	02/20/2020

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Directions to “ SIMINIBE MONEKE NURSE PRACTITIONER” Practice Location

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