Individual
CHANELLE INJEH KUNSEH FOMBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4215 JOE RAMSEY BLVD E, GREENVILLE, TX 75401-7852
(903) 408-5000
Mailing address
501 AIR PARK AVE, GREENVILLE, TX 75402-3000
(903) 408-5834
(903) 408-5693
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024188872
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
1019684
TX
Other
Enumeration date
06/09/2021
Last updated
02/11/2025
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