Healthcare Provider Details

I. General information

NPI: 1578035226
Provider Name (Legal Business Name): DOROTHY NYAKERARIO OKIOMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY NYAKERARIO OKIOMA NURSE

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W SEMANDS ST
CONROE TX
77301-1867
US

IV. Provider business mailing address

811 INTERSTATE 45 S APT 234
CONROE TX
77301-4212
US

V. Phone/Fax

Practice location:
  • Phone: 935-756-5598
  • Fax: 936-249-2244
Mailing address:
  • Phone: 862-899-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number952146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: