MAKEBA WALLER (NPI# 1790224210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790224210 |
| Entity Type | Individual |
| Full Name | MAKEBA WALLER |
| Practice Address |
1719 Almond Dr Mansfield TX 76063-2916 |
| Mailing Address |
Po Box 585 Mansfield TX 76063-0585 |
| Practice Telephone | 8172352235 |
| Mailing Telephone | 8172352234 |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2017-02-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2471S1302X |
Radiologic Technologist Specialization: Sonography |
42313 | TX | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
1719 ALMOND DR |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063-2916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 2471S1302X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Sonography |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952924730 | Michael Testa Jr. | Radiologic Technologist | 3801 N Lamar Blvd # 350, Austin, TX 78756-4080 | 2020-05-27 |
| 1174143713 | Casey Lunt | Radiologic Technologist | 4621 Dusk Meadow Dr, Carrollton, TX 75010-2069 | 2020-04-23 |
| 1083242093 | Bridget Andersen | Radiologic Technologist | 4618 Avenue R 1/2, Galveston, TX 77551-5327 | 2020-03-27 |
| 1972141901 | Reynaldo Reyes | Radiologic Technologist | 9801 Royal Ln Apt 307, Dallas, TX 75231-1825 | 2019-12-20 |
| 1588222772 | Tiessa Lurae Self | Radiologic Technologist | 927 Strawberry Rd, Pasadena, TX 77506-4821 | 2019-06-03 |
| 1275922445 | Brandon Holbert | Radiologic Technologist | 310 San Mateo Ct, Irving, TX 75062-4509 | 2015-01-12 |
| 1346657921 | Kellie A Arce | Radiologic Technologist | 2056 Sundance Pkwy Apt 2320, New Braunfels, TX 78130-2790 | 2014-07-16 |
| 1205242674 | Shiva Ghazizadeh | Radiologic Technologist | 1304 W Branch Hollow Dr, Carrollton, TX 75007-1144 | 2014-07-07 |
| 1336562461 | Rajesh Mehta | Radiologic Technologist | 3527 Highway 6, Suite 270, Sugar Land, TX 77478-4519 | 2014-01-24 |
| 1932521697 | Amber Yound | Radiologic Technologist | 350 W Highland Blvd, San Angelo, TX 76903-7313 | 2014-01-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.