Provider Demographics
NPI:1861902934
Name:MONEKE, SIMINIBE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SIMINIBE
Middle Name:
Last Name:MONEKE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SIMINIBE
Other - Middle Name:P
Other - Last Name:MONEKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:111 EXECUTIVE WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2388
Mailing Address - Country:US
Mailing Address - Phone:469-941-4029
Mailing Address - Fax:866-803-8759
Practice Address - Street 1:111 EXECUTIVE WAY STE 102
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2388
Practice Address - Country:US
Practice Address - Phone:469-941-4029
Practice Address - Fax:866-803-8759
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty