Provider Demographics
NPI:1215226246
Name:JUMBO, CHIKAODILI (NP)
Entity type:Individual
Prefix:MISS
First Name:CHIKAODILI
Middle Name:
Last Name:JUMBO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 EGRET BAY BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3239
Mailing Address - Country:US
Mailing Address - Phone:281-332-3001
Mailing Address - Fax:281-332-3005
Practice Address - Street 1:18333 EGRET BAY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3239
Practice Address - Country:US
Practice Address - Phone:281-332-3001
Practice Address - Fax:281-332-3005
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045490363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care