Healthcare Provider Details

I. General information

NPI: 1609245430
Provider Name (Legal Business Name): EDWIGE FLORE KOUMFIEG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24802 ALDINE WFLD RD
SPRING TX
77373-5926
US

IV. Provider business mailing address

24802 ALDINE WESTFIELD RD
SPRING TX
77373-5926
US

V. Phone/Fax

Practice location:
  • Phone: 281-288-1561
  • Fax:
Mailing address:
  • Phone: 870-230-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0815119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: