MEDICARE: DR. NDUBUISI DAVID ODIMEGWU AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP137648	TX
2	363LP2300X	Primary Care Nurse Practitioner	AP137648	TX
3	363LG0600X	Gerontology Nurse Practitioner	AP137648	TX

General Provider Information

NPI Number	:	1043702467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NDUBUISI DAVID ODIMEGWU AGNP-C

Provider Business Mailing Address
First Line	:	1934 PLUM CREEK LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-4165
Country	:	US
Telephone Number	:	651-353-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 W RIDGECREEK DR STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3536
Country	:	US
Telephone Number	:	346-223-2195
Fax Number	:	346-998-1550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	08/11/2024

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