MEDICARE: ROSELINE EKUMA FNP

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	363LF0000X	Family Nurse Practitioner	AP138139	TX

General Provider Information

NPI Number	:	1124506944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELINE EKUMA FNP

Provider Business Mailing Address
First Line	:	24531 TRIBECA LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-2694
Country	:	US
Telephone Number	:	832-549-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	281-704-3836
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	08/02/2018

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