Provider Demographics
NPI:1093339087
Name:EGEBE, NATHALIA ABE (NP)
Entity Type:Individual
Prefix:MRS
First Name:NATHALIA
Middle Name:ABE
Last Name:EGEBE
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 1:21426 AVALON QUEEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5910
Mailing Address - Country:US
Mailing Address - Phone:240-701-4605
Mailing Address - Fax:
Practice Address - Street 1:17567 IMPERIAL VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-6102
Practice Address - Country:US
Practice Address - Phone:832-368-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner