MEDICARE: NGOZI D. MBUE 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	163W00000X	Registered Nurse	148023	MO
2	363LA2200X	Adult Health Nurse Practitioner	A0403076	MO
3	363LA2200X	Adult Health Nurse Practitioner	AP117900	TX

General Provider Information

NPI Number	:	1982670600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGOZI D. MBUE NP

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR
Second Line	:	SUITE 1-100
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	713-500-2153
Fax Number	:	713-500-2171

Provider Business Practice Location Address
First Line	:	909 FROSTWOOD DR
Second Line	:	SUITE 1-100
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	713-500-2153
Fax Number	:	713-500-2171

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	06/27/2014

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