Healthcare Provider Details

I. General information

NPI: 1730807892
Provider Name (Legal Business Name): OLUWATOYIN GRACE UKINAMEMEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13621 SKINNER RD
CYPRESS TX
77429-7278
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 281-888-8514
  • Fax:
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1075453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: