Healthcare Provider Details

I. General information

NPI: 1023482239
Provider Name (Legal Business Name): ESELE UWAGWE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9297 WAHRENBERGER RD
CONROE TX
77304-2441
US

IV. Provider business mailing address

9297 WAHRENBERGER RD
CONROE TX
77304-2441
US

V. Phone/Fax

Practice location:
  • Phone: 936-788-7770
  • Fax:
Mailing address:
  • Phone: 936-777-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: