Provider Demographics
NPI:1285494146
Name:CHIEDU, STEPHANIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHIEDU
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WILCREST DR # 157
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3365
Mailing Address - Country:US
Mailing Address - Phone:346-233-1030
Mailing Address - Fax:
Practice Address - Street 1:3000 WILCREST DR STE 157
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3365
Practice Address - Country:US
Practice Address - Phone:346-233-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9303601744P3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management