Provider Demographics
NPI:1902394554
Name:AKUM, PRUDENTIA CHAH
Entity Type:Individual
Prefix:
First Name:PRUDENTIA
Middle Name:CHAH
Last Name:AKUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5119
Mailing Address - Country:US
Mailing Address - Phone:972-201-4979
Mailing Address - Fax:
Practice Address - Street 1:525 GRANADA DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5119
Practice Address - Country:US
Practice Address - Phone:972-201-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309486164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse