Healthcare Provider Details

I. General information

NPI: 1043403900
Provider Name (Legal Business Name): MARTHA WIMBERLY OLOOMI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA JEAN WIMBERLY-OLOOMI

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD SCI/REHAB/NEURO SERVICE LINE
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

V. Phone/Fax

Practice location:
  • Phone: 281-980-0465
  • Fax:
Mailing address:
  • Phone: 281-980-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number251509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: