Provider Demographics
NPI:1427528256
Name:ATIVIE, MARY AIFEKELU (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:AIFEKELU
Last Name:ATIVIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 MISSION ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5376
Mailing Address - Country:US
Mailing Address - Phone:713-962-1824
Mailing Address - Fax:832-532-7301
Practice Address - Street 1:8226 MISSION ESTATES DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5376
Practice Address - Country:US
Practice Address - Phone:713-962-1824
Practice Address - Fax:832-532-7301
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX714556163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics