Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP144271 | TX |
NPI | 1013548189 |
---|---|
Provider Name | Grace Ovuegbe Alozie |
First Address | Portland, TX 78374-3202 |
Second Address | San Antonio, TX 78251-2885 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2020 |
Last Update Date | 28/01/2020 |