Provider Demographics
NPI:1083114854
Name:EDEWOR, EKEMENA
Entity Type:Individual
Prefix:
First Name:EKEMENA
Middle Name:
Last Name:EDEWOR
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 1:26303 SMOKEY VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2782
Mailing Address - Country:US
Mailing Address - Phone:713-922-7436
Mailing Address - Fax:
Practice Address - Street 1:26303 SMOKEY VALLEY LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2782
Practice Address - Country:US
Practice Address - Phone:713-922-7436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse