Individual
AFANWI MBONCHOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7519 EASTWOOD LAKE LN, RICHMOND, TX 77407-2878
(781) 859-8258
Mailing address
7519 EASTWOOD LAKE LN, RICHMOND, TX 77407-2878
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
908779
TX
363L00000X
Nurse Practitioner
Primary
AP145226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
908779
TEXAS BOARD OF NURSING
TX
Enumeration date
09/06/2019
Last updated
10/03/2023
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