Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2012005776 | TX |
NPI | 1023363264 |
---|---|
Provider Name | Anne Ndunge Ndolo |
First Address | Houston, TX 77075-4874 |
Second Address | Houston, TX 77075-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 04/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
311610501 | (05) | TX |