Anastasia Nanyongo Matute
Nurse Practitioner, Psych/Mental Health in Grand Prairie, TX. Individual provider (NPI-1).
NPI number1669932976
StatusActive
Last updated in NPPESOct 13, 2024
Details
- NPI
- 1669932976
- Entity type
- Individual (NPI-1)
- Name
- Anastasia Nanyongo Matute
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 22, 2019
- Certification date
- Oct 13, 2024
- Last updated
- Oct 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 1156040 | TX | Yes |
| 163W00000X | Registered Nurse | 904608 | TX |
Practice location
2100 Virginia StGrand Prairie, TX 75051-3796
Phone 405-436-1909
Mailing address
2100 Virginia StGrand Prairie, TX 75051-3796
Phone 405-436-1909
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