Individual
DIANNA INGABIRE MANIGABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(682) 404-9606
Mailing address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(682) 404-9606
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1003610
TX
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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