Healthcare Provider Details

I. General information

NPI: 1861990681
Provider Name (Legal Business Name): NITTA OGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 JOHN HANCOCK LANE
MISSOURI CITY TX
77459
US

IV. Provider business mailing address

3631 JOHN HANCOCK LANE
MISSOURI CITY TX
77459
US

V. Phone/Fax

Practice location:
  • Phone: 281-384-8731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP136063
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP136063
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: