Provider Demographics
NPI:1053894600
Name:MUDZANA, ELISHA
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:MUDZANA
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 1:6009 W PARKER RD STE 149-402
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8120
Mailing Address - Country:US
Mailing Address - Phone:214-660-6830
Mailing Address - Fax:
Practice Address - Street 1:7116 LIBBY RD # 4253
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4937
Practice Address - Country:US
Practice Address - Phone:214-660-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner