Healthcare Provider Details

I. General information

NPI: 1992790042
Provider Name (Legal Business Name): MERCY TITILOLA OTUNLA APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/20/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 FANNIN ST STE 260
HOUSTON TX
77054-1990
US

IV. Provider business mailing address

7500 FANNIN ST STE 260
HOUSTON TX
77054-1990
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number616624
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: