MEDICARE: HENRIETTA AYONG RN

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	163W00000X	Registered Nurse	824933	TX
2	372600000X	Adult Companion
3	374J00000X	Doula

General Provider Information

NPI Number	:	1669898557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRIETTA AYONG RN

Provider Business Mailing Address
First Line	:	13835 WESTHOLLOW PARK DR
Second Line	:	2805
City	:	HOUSTON
State	:	TX
Zip	:	77082-1874
Country	:	US
Telephone Number	:	832-417-3042
Fax Number	:

Provider Business Practice Location Address
First Line	:	13835 WESTHOLLOW PARK DR
Second Line	:	2805
City	:	HOUSTON
State	:	TX
Zip	:	77082-1874
Country	:	US
Telephone Number	:	832-417-3042
Fax Number	:

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

Provider Enumeration Date	:	03/15/2014
Last Update Date	:	03/15/2014

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