Provider Demographics
NPI:1417438938
Name:CHINWUBA, EDITH
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:CHINWUBA
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 1:19400 W BELLFORT ST APT 5216
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8215
Mailing Address - Country:US
Mailing Address - Phone:281-736-7407
Mailing Address - Fax:
Practice Address - Street 1:10101 FONDREN RD STE 428
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5133
Practice Address - Country:US
Practice Address - Phone:713-772-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331883164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse