Provider Demographics
NPI:1043395197
Name:NWOKENAKA, CORNELIUS
Entity Type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:
Last Name:NWOKENAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9888 BISSONNET ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8247
Mailing Address - Country:US
Mailing Address - Phone:713-541-1667
Mailing Address - Fax:713-541-2669
Practice Address - Street 1:9888 BISSONNET ST
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8247
Practice Address - Country:US
Practice Address - Phone:713-541-1667
Practice Address - Fax:713-541-2669
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0063812332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155599701Medicaid
TX155599702Medicaid