Healthcare Provider Details

I. General information

NPI: 1740211531
Provider Name (Legal Business Name): FIDELIA IJEURU UKAH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19900 HWY. 59
SUGAR LAND TX
77479
US

IV. Provider business mailing address

12810 CANDACE CT
MISSOURI CITY TX
77489-3957
US

V. Phone/Fax

Practice location:
  • Phone: 281-341-8330
  • Fax: 713-358-4805
Mailing address:
  • Phone: 281-261-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number580397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: