Provider Demographics
NPI:1043792542
Name:AZANWI, GWENDOLINE NGWEBOH
Entity Type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:NGWEBOH
Last Name:AZANWI
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 1:12707 BELLAIRE BLVD APT 1526
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2176
Mailing Address - Country:US
Mailing Address - Phone:469-335-6405
Mailing Address - Fax:
Practice Address - Street 1:12707 BELLAIRE BLVD APT 1526
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2176
Practice Address - Country:US
Practice Address - Phone:469-335-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313663164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse