MEDICARE: MRS. NGOZI JOSEPHINE MBAGWU

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	144445	TX

General Provider Information

NPI Number	:	1760013924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NGOZI JOSEPHINE MBAGWU

Provider Business Mailing Address
First Line	:	2123 LAUREL CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2468
Country	:	US
Telephone Number	:	832-982-4495
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 LAUREL CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2468
Country	:	US
Telephone Number	:	832-982-4495
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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