Healthcare Provider Details

I. General information

NPI: 1184186116
Provider Name (Legal Business Name): PRISCILLA AMAKA OGUNNOWO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11618 OGUNNOWO LN
HOUSTON TX
77031-1513
US

IV. Provider business mailing address

11618 OGUNNOWO LN
HOUSTON TX
77031-1513
US

V. Phone/Fax

Practice location:
  • Phone: 832-457-0943
  • Fax: 713-981-4089
Mailing address:
  • Phone: 832-457-0943
  • Fax: 713-981-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: