Provider Demographics
NPI:1013807114
Name:MUCHAPONDWA, HAPHEN
Entity type:Individual
Prefix:
First Name:HAPHEN
Middle Name:
Last Name:MUCHAPONDWA
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 1:320 S STATE HIGHWAY 121 N STE J207
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3882
Mailing Address - Country:US
Mailing Address - Phone:800-758-9151
Mailing Address - Fax:
Practice Address - Street 1:320 S STATE HIGHWAY 121 N STE J207
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3882
Practice Address - Country:US
Practice Address - Phone:800-758-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21333172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker