Provider Demographics
NPI:1902300965
Name:KAMBANJE, MONALISA (NP)
Entity Type:Individual
Prefix:MISS
First Name:MONALISA
Middle Name:
Last Name:KAMBANJE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W PRESIDENT GEORGE BUSH HWY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1135
Mailing Address - Country:US
Mailing Address - Phone:469-332-7925
Mailing Address - Fax:
Practice Address - Street 1:612 E LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:682-236-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135158363LG0600X
CA95008983363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology