Provider Demographics
NPI:1023363264
Name:NDOLO, ANNE NDUNGE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:NDUNGE
Last Name:NDOLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 S SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4874
Mailing Address - Country:US
Mailing Address - Phone:713-343-2301
Mailing Address - Fax:
Practice Address - Street 1:8511 S SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4874
Practice Address - Country:US
Practice Address - Phone:713-343-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012005776363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311610501Medicaid
TX264083YLGGMedicare PIN