Gwendoline Mbaku, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP129670 Issued in TX

Practice address

3133 E Lemmon Ave
Dallas, TX 75204-1411

Phone

(866) 389-2727

Fax

(401) 216-3854

NPI assigned

Nov 23, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Physiatry Group LLC

  • Physical Medicine & Rehabilitation Physician
  • Plano, TX
  • NPI 1316078769
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1447624853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15175 PALO PINTO DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750355556",
            "telephone_number": "214-682-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3133 E LEMMON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752041411",
            "telephone_number": "866-389-2727",
            "fax_number": "401-216-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBAKU",
        "first_name": "GWENDOLINE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-23",
        "last_updated": "2016-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP129670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3567679",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mba General Management LTD
• CHI Mba
• Emiline A Mba
• Racheal Mba
• Dianne Mbai, APRN
• Mbanks Foundation for the Homeless With Mental Illness
• MBB Management
• Mbe Dynamic Healthcare Services, Inc
• Mbidx
• Mbmurphy, PLLC

• Family Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.