Healthcare Provider Details

I. General information

NPI: 1871115261
Provider Name (Legal Business Name): ULOMA UDEZE OKUNDAYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 AVENUE H
ROSENBERG TX
77471-2833
US

IV. Provider business mailing address

9722 GASTON RD STE 150-102
KATY TX
77494-7941
US

V. Phone/Fax

Practice location:
  • Phone: 281-725-6182
  • Fax:
Mailing address:
  • Phone: 818-571-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number891744
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145527
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP145973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: