Provider Demographics
NPI:1730903733
Name:EMMELINE, NINDAGIYE
Entity type:Individual
Prefix:
First Name:NINDAGIYE
Middle Name:
Last Name:EMMELINE
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 1:2818 BLACKWOLF DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253-2506
Mailing Address - Country:US
Mailing Address - Phone:469-416-6068
Mailing Address - Fax:
Practice Address - Street 1:2818 BLACKWOLF DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-2506
Practice Address - Country:US
Practice Address - Phone:469-416-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician