Healthcare Provider Details

I. General information

NPI: 1902311228
Provider Name (Legal Business Name): CHRISTY O. EJIOFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9402 TOLKEN WAY
SUGAR LAND TX
77498-7578
US

IV. Provider business mailing address

9402 TOLKEN WAY
SUGAR LAND TX
77498-7578
US

V. Phone/Fax

Practice location:
  • Phone: 508-615-6389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP135989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: