Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AP137648 | TX |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP137648 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP137648 | TX |
NPI | 1043702467 |
---|---|
Provider Name | Ndubuisi David Odimegwu |
First Address | Missouri City, TX 77489-4165 |
Second Address | Houston, TX 77053-3536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 14/01/2022 |