Healthcare Provider Details

I. General information

NPI: 1083223804
Provider Name (Legal Business Name): PATRICIA NMUKOSO ENYI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 S LOOP W STE 270
HOUSTON TX
77054-5608
US

IV. Provider business mailing address

2646 S LOOP W STE 270
HOUSTON TX
77054-5608
US

V. Phone/Fax

Practice location:
  • Phone: 713-668-4141
  • Fax: 713-668-4142
Mailing address:
  • Phone: 713-668-4141
  • Fax: 713-668-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP145257
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: