Healthcare Provider Details

I. General information

NPI: 1558921130
Provider Name (Legal Business Name): MILLICENT OKWUEZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 BRIGHT NIGHT DR
RICHMOND TX
77407-2661
US

IV. Provider business mailing address

8510 BRIGHT NIGHT DR
RICHMOND TX
77407-2661
US

V. Phone/Fax

Practice location:
  • Phone: 832-692-0529
  • Fax:
Mailing address:
  • Phone: 832-692-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number345864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: