Healthcare Provider Details

I. General information

NPI: 1669148789
Provider Name (Legal Business Name): OLUCHI IJEOMA UWAJUMOGU NP 1051106
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E HIGHWAY 114 STE 350
TROPHY CLUB TX
76262-5309
US

IV. Provider business mailing address

16515 LEXINGTON BLVD
SUGAR LAND TX
77479-2310
US

V. Phone/Fax

Practice location:
  • Phone: 855-204-2502
  • Fax: 817-783-4672
Mailing address:
  • Phone: 281-980-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1051106
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: