Healthcare Provider Details

I. General information

NPI: 1669239745
Provider Name (Legal Business Name): GLADYS UWAKWEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17433 DORNACH DR
PFLUGERVILLE TX
78660-1704
US

IV. Provider business mailing address

17433 DORNACH DR
PFLUGERVILLE TX
78660-1704
US

V. Phone/Fax

Practice location:
  • Phone: 512-788-6912
  • Fax:
Mailing address:
  • Phone: 512-788-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number971867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: