Provider Demographics
NPI:1033690391
Name:IMO, NNEAMAKA VICTORIA
Entity Type:Individual
Prefix:
First Name:NNEAMAKA
Middle Name:VICTORIA
Last Name:IMO
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 1:11924 BRAES PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-3279
Mailing Address - Country:US
Mailing Address - Phone:832-221-2402
Mailing Address - Fax:
Practice Address - Street 1:11924 BRAES PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-7707
Practice Address - Country:US
Practice Address - Phone:832-989-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853908163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse