MEDICARE: FURO UBA FABUNMI 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	AP144328	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP144328	TX

General Provider Information

NPI Number	:	1730719014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FURO UBA FABUNMI NP

Provider Business Mailing Address
First Line	:	1219 ORANGE PUMPKIN LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-1771
Country	:	US
Telephone Number	:	832-388-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 ORANGE PUMPKIN LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-1771
Country	:	US
Telephone Number	:	832-388-0065
Fax Number	:

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

Provider Enumeration Date	:	01/25/2020
Last Update Date	:	10/16/2024

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