Provider Demographics
NPI:1316425564
Name:IGBO, GRACE (LVN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:IGBO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 BISSONNET ST APT 705
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2430
Mailing Address - Country:US
Mailing Address - Phone:832-885-1549
Mailing Address - Fax:
Practice Address - Street 1:9000 BISSONNET ST APT 705
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2430
Practice Address - Country:US
Practice Address - Phone:832-885-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227469164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse