Provider Demographics
NPI:1447819008
Name:KAVUANDA, VICTORIA TSHIBOLA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TSHIBOLA
Last Name:KAVUANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TSHIBOLA
Other - Middle Name:
Other - Last Name:KAMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5521 SPRINGFORD CICLE
Mailing Address - Street 2:APT 1825
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-987-7848
Mailing Address - Fax:
Practice Address - Street 1:5521 SPRINGFORD CIR APT 1825
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5370
Practice Address - Country:US
Practice Address - Phone:817-987-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX958636163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse