Healthcare Provider Details

I. General information

NPI: 1184153249
Provider Name (Legal Business Name): ROSETTE NKUDOM NJIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9107 PINE PLACE CT
CYPRESS TX
77433-0034
US

IV. Provider business mailing address

16820 WEST RD
HOUSTON TX
77095-5577
US

V. Phone/Fax

Practice location:
  • Phone: 832-722-4939
  • Fax:
Mailing address:
  • Phone: 281-667-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2079883
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: