Healthcare Provider Details

I. General information

NPI: 1497495147
Provider Name (Legal Business Name): QUEEN OHUABUNWA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16131 N ELDRIDGE PKWY STE 100
TOMBALL TX
77377-9130
US

IV. Provider business mailing address

8634 PLANTERS MOON LN
RICHMOND TX
77407-2771
US

V. Phone/Fax

Practice location:
  • Phone: 832-639-1544
  • Fax:
Mailing address:
  • Phone: 713-550-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1107111
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: