MEDICARE: GWENDOLINE N CHUBA

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	363L00000X	Nurse Practitioner	AP136740	TX
2	363LG0600X	Gerontology Nurse Practitioner	AP136740	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP136740	OTHER	TX	APRN LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316432750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLINE N CHUBA

Provider Business Mailing Address
First Line	:	925 S MASON RD # 147
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3874
Country	:	US
Telephone Number	:	281-929-9770
Fax Number	:	832-336-3831

Provider Business Practice Location Address
First Line	:	419 VINTAGE LN
Second Line	:
City	:	BROOKSHIRE
State	:	TX
Zip	:	77423-3172
Country	:	US
Telephone Number	:	281-929-9770
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	06/06/2025

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Directions to “ GWENDOLINE N CHUBA ” Practice Location

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