Basic Information
| Provider Information | |||||||||
| NPI: | 1477183465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MLONDIWA | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | CHISHONGO | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370753871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173204126 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 PINE ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256702000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2020 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP144801 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 124831 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.