MEDICARE: MR. EMMANUEL NDUBUISI NWABUDE

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP132370	TX

General Provider Information

NPI Number	:	1861944993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EMMANUEL NDUBUISI NWABUDE

Provider Business Mailing Address
First Line	:	502 S POST OAK LN
Second Line	:	APT 232
City	:	HOUSTON
State	:	TX
Zip	:	77056-1448
Country	:	US
Telephone Number	:	580-736-0343
Fax Number	:

Provider Business Practice Location Address
First Line	:	14335 TORREY CHASE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1634
Country	:	US
Telephone Number	:	281-631-0081
Fax Number	:

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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