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General NPI Number Information
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NPI Number | 1790169548
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Entity Type | Organization
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Legal Business Name | SHILOH C DIVINE HEALTHCARE SERVICE
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Dates
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Enumeration Date | 07/11/2015
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Last Update Date | 07/11/2015
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Provider Practice Location Address
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Address Line | 14406 PARKESGATE DR
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City | HOUSTON
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State | TX
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Zip | 77083-5789
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Country | US
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Telephone | 832-212-4739
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Fax |
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Provider Business Mailing Address
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Address Line | 14406 PARKESGATE DR
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City | HOUSTON
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State | TX
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Zip | 77083-5789
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MRS. EMILIANA OMAWUMI EZECHIGBO
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Credential | APRN
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Telephone | 832-212-4739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP128425
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License Number State | TX
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