Individual
ANASTASIA NANYONGO MATUTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 VIRGINIA ST, GRAND PRAIRIE, TX 75051-3796
(405) 436-1909
Mailing address
2100 VIRGINIA ST, GRAND PRAIRIE, TX 75051-3796
(405) 436-1909
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
904608
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1156040
TX
Other
Enumeration date
03/22/2019
Last updated
10/13/2024
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