Healthcare Provider Details

I. General information

NPI: 1417583188
Provider Name (Legal Business Name): UDEZUO OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25502 CANYON CROSSING DR
RICHMOND TX
77406-7277
US

IV. Provider business mailing address

1155 DAIRY ASHFORD RD STE 560
HOUSTON TX
77079-3035
US

V. Phone/Fax

Practice location:
  • Phone: 708-977-7774
  • Fax:
Mailing address:
  • Phone: 713-799-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number803030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: