Healthcare Provider Details

I. General information

NPI: 1336173327
Provider Name (Legal Business Name): EUNICE E GBENOBA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 FANNIN ST SUITE 1101
HOUSTON TX
77030-2717
US

IV. Provider business mailing address

6550 FANNIN ST SUITE 1101
HOUSTON TX
77030-2717
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-0006
  • Fax: 713-790-2727
Mailing address:
  • Phone: 713-441-0006
  • Fax: 713-790-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number558854
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP113893
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: