Healthcare Provider Details

I. General information

NPI: 1417311093
Provider Name (Legal Business Name): ELIZABETH MBUTU-LOMELI N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GESSNER RD STE 680
HOUSTON TX
77024-2525
US

IV. Provider business mailing address

16406 PINON VISTA DR
HOUSTON TX
77095-6979
US

V. Phone/Fax

Practice location:
  • Phone: 713-827-8710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP130594
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: