Individual
MAFON FOMUJANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2911 MEDICAL ARTS ST STE 10, AUSTIN, TX 78705-3302
(866) 473-0663
Mailing address
32638 HARVEST VALLEY DR, BROOKSHIRE, TX 77423-2908
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1048371
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN.CNP.023666
OH
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
023666
OH
Other
Enumeration date
04/26/2017
Last updated
07/03/2023
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