Provider Demographics
NPI:1871922781
Name:ASENA, GERTRUDE WANDAKA (FNP)
Entity type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:WANDAKA
Last Name:ASENA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24048 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5326
Mailing Address - Country:US
Mailing Address - Phone:832-362-4075
Mailing Address - Fax:
Practice Address - Street 1:24048 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5326
Practice Address - Country:US
Practice Address - Phone:832-362-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX767742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily