MEDICARE: OBINWANNE PRINCESS GBUGU APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	802275	TX

General Provider Information

NPI Number	:	1457153983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBINWANNE PRINCESS GBUGU APRN

Provider Business Mailing Address
First Line	:	1822 ALBERT GLADE CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2380
Country	:	US
Telephone Number	:	361-461-2716
Fax Number	:

Provider Business Practice Location Address
First Line	:	1822 ALBERT GLADE CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2380
Country	:	US
Telephone Number	:	361-461-2716
Fax Number	:

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

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	01/22/2026

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