=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730559717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLUBUNMI OLUFUNKE KAZZIM FNP - C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2015
-----------------------------------------------------
Last Update Date | 10/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14520 OLD KATY RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-847-1527
-----------------------------------------------------
Fax | 281-558-3432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14520 OLD KATY RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-847-1527
-----------------------------------------------------
Fax | 281-558-3432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP128920
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------