Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP141767 | TX |
NPI | 1013579176 |
---|---|
Provider Name | Mrs. Agatha Ogechi Duru |
First Address | Houston, TX 77036-8039 |
Second Address | Houston, TX 77036-8039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |