Provider Demographics
NPI:1023590015
Name:NYASA, GWENDOLINE VALAH (RN)
Entity type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:VALAH
Last Name:NYASA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E FRANKFORD RD APT 114
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5650
Mailing Address - Country:US
Mailing Address - Phone:704-465-1563
Mailing Address - Fax:
Practice Address - Street 1:3115 HELMET ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3409
Practice Address - Country:US
Practice Address - Phone:704-465-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875913163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics