Provider Demographics
NPI:1427749118
Name:ITAUMA, MARY EKEMINI (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:EKEMINI
Last Name:ITAUMA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 HACKMATACK WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066
Mailing Address - Country:US
Mailing Address - Phone:713-992-9235
Mailing Address - Fax:
Practice Address - Street 1:13523 HARGRAVE RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3829
Practice Address - Country:US
Practice Address - Phone:281-949-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily