Provider Demographics
NPI:1114649415
Name:IYAMU, IYORE DORIS (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:IYORE
Middle Name:DORIS
Last Name:IYAMU
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 CLAYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1767
Mailing Address - Country:US
Mailing Address - Phone:832-497-7845
Mailing Address - Fax:
Practice Address - Street 1:411 PARK GROVE DR STE 310
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1580
Practice Address - Country:US
Practice Address - Phone:281-579-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089254363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care