Provider Demographics
NPI:1104052182
Name:ENYIOMA, ROSE N
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:N
Last Name:ENYIOMA
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 1:8449 W BELLFORT ST
Mailing Address - Street 2:# 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2245
Mailing Address - Country:US
Mailing Address - Phone:713-774-9300
Mailing Address - Fax:
Practice Address - Street 1:8449 W BELLFORT ST
Practice Address - Street 2:# 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2245
Practice Address - Country:US
Practice Address - Phone:713-774-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639196163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176876401Medicaid
TX457888Medicare Oscar/Certification