Healthcare Provider Details

I. General information

NPI: 1013264464
Provider Name (Legal Business Name): COMFORT UMEZULIKE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12209 PLANO RD APT 2023
DALLAS TX
75243-9136
US

IV. Provider business mailing address

12209 PLANO RD APT 2023
DALLAS TX
75243-9136
US

V. Phone/Fax

Practice location:
  • Phone: 817-779-2968
  • Fax:
Mailing address:
  • Phone: 817-779-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number42968
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: