Provider Demographics
NPI:1538721832
Name:TUMBO, EDWIN NYARANGI
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:NYARANGI
Last Name:TUMBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 GUMWOOD DR APT 1511
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2833
Mailing Address - Country:US
Mailing Address - Phone:682-551-8204
Mailing Address - Fax:
Practice Address - Street 1:2501 GUMWOOD DR APT 1511
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2833
Practice Address - Country:US
Practice Address - Phone:682-551-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348505164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse