Healthcare Provider Details

I. General information

NPI: 1346861317
Provider Name (Legal Business Name): IFEOMA PAMELA OKOYE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IFEOMA ANAKOR CRNA

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

18101 POINT LOOKOUT DR APT 202
HOUSTON TX
77058-3580
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1011
  • Fax:
Mailing address:
  • Phone: 832-428-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number126451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: