Healthcare Provider Details

I. General information

NPI: 1649387630
Provider Name (Legal Business Name): UGHANMWAN EFEOVBOKHAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 ROUGHRIDER DR
WINDCREST TX
78239-2428
US

IV. Provider business mailing address

8101 ROUGHRIDER DR
WINDCREST TX
78239-2428
US

V. Phone/Fax

Practice location:
  • Phone: 210-657-3700
  • Fax: 210-657-3708
Mailing address:
  • Phone: 210-657-3700
  • Fax: 210-657-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number683669
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number683669
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP113326
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: