MEDICARE: UGHANMWAN EFEOVBOKHAN NP

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	163WW0000X	Wound Care Registered Nurse	683669	TX
2	363LG0600X	Gerontology Nurse Practitioner	683669	TX
3	363LG0600X	Gerontology Nurse Practitioner	AP113326	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649387630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UGHANMWAN EFEOVBOKHAN NP

Provider Business Mailing Address
First Line	:	8101 ROUGHRIDER DR
Second Line	:
City	:	WINDCREST
State	:	TX
Zip	:	78239-2428
Country	:	US
Telephone Number	:	210-657-3700
Fax Number	:	210-657-3700

Provider Business Practice Location Address
First Line	:	8101 ROUGHRIDER DR
Second Line	:
City	:	WINDCREST
State	:	TX
Zip	:	78239-2428
Country	:	US
Telephone Number	:	210-657-3700
Fax Number	:	210-657-3708

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	01/30/2025

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