MEDICARE: EZENWANYI QUEEN KANU 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	1168728	TX

General Provider Information

NPI Number	:	1316775992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZENWANYI QUEEN KANU FNP

Provider Business Mailing Address
First Line	:	4918 HICKORY DEER LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2996
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1875 HIGHWAY 6 STE 300
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-5098
Country	:	US
Telephone Number	:	832-604-5332
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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Directions to “ EZENWANYI QUEEN KANU FNP” Practice Location

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