MEDICARE: NWANNEOMA PATRICIA NDUBISI FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP135064	TX

General Provider Information

NPI Number	:	1063926749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NWANNEOMA PATRICIA NDUBISI FNP

Provider Business Mailing Address
First Line	:	9100 SOUTHWEST FWY STE 100A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1523
Country	:	US
Telephone Number	:	281-310-7169
Fax Number	:	866-407-9992

Provider Business Practice Location Address
First Line	:	9100 SOUTHWEST FWY STE 100A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1523
Country	:	US
Telephone Number	:	281-310-7169
Fax Number	:	866-407-9992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	10/31/2023

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