Individual
ELODIE FONGANG MAFO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11911 GREENVILLE AVE APT 2213, DALLAS, TX 75243-3667
(515) 346-2913
Mailing address
11911 GREENVILLE AVE APT 2213, DALLAS, TX 75243-3667
(515) 346-2913
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
977966
TX
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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