MEDICARE: LINDA C EZENNIA

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	1048873	TX

General Provider Information

NPI Number	:	1932855731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA C EZENNIA

Provider Business Mailing Address
First Line	:	5123 BLUE CANOE RD
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-1619
Country	:	US
Telephone Number	:	281-995-0641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 S LOOP W STE 525
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2691
Country	:	US
Telephone Number	:	832-378-8282
Fax Number	:

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

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	10/13/2022

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Directions to “ LINDA C EZENNIA ” Practice Location

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