Provider Demographics
NPI:1063994473
Name:FONABEI, PATRICIA ABONG
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ABONG
Last Name:FONABEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15543 KIPLANDS BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1536
Mailing Address - Country:US
Mailing Address - Phone:813-407-8739
Mailing Address - Fax:
Practice Address - Street 1:4502 RIVERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5204
Practice Address - Country:US
Practice Address - Phone:832-461-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX934009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse