MEDICARE: MILLICENT IFEOMA ELUMELU

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	164X00000X	Licensed Vocational Nurse	323800	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1133365	TX

General Provider Information

NPI Number	:	1093282014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILLICENT IFEOMA ELUMELU

Provider Business Mailing Address
First Line	:	16155 MISSION GLEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5381
Country	:	US
Telephone Number	:	832-373-2063
Fax Number	:

Provider Business Practice Location Address
First Line	:	16155 MISSION GLEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5381
Country	:	US
Telephone Number	:	832-373-2063
Fax Number	:

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	05/28/2024

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Directions to “ MILLICENT IFEOMA ELUMELU ” Practice Location

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