MEDICARE: MRS. PATRICIA NMUKOSO ENYI 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	207Q00000X	Family Medicine Physician	AP145257	TX

General Provider Information

NPI Number	:	1083223804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA NMUKOSO ENYI FNP

Provider Business Mailing Address
First Line	:	2646 S LOOP W STE 270
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5608
Country	:	US
Telephone Number	:	713-668-4141
Fax Number	:	713-668-4142

Provider Business Practice Location Address
First Line	:	2646 S LOOP W STE 270
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5608
Country	:	US
Telephone Number	:	713-668-4141
Fax Number	:	713-668-4142

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	07/28/2020

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