Healthcare Provider Details

I. General information

NPI: 1215420559
Provider Name (Legal Business Name): JOYCE IDEHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE SADIKU RN

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 MEMORIAL HERMANN DR STE 130
PEARLAND TX
77584-3773
US

IV. Provider business mailing address

PO BOX 57845
WEBSTER TX
77598-7845
US

V. Phone/Fax

Practice location:
  • Phone: 346-288-8746
  • Fax: 346-200-3841
Mailing address:
  • Phone: 346-288-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number865223
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW2077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: