Provider Demographics
NPI:1184863797
Name:MORTIMER-ORAGWU, MILADY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MILADY
Middle Name:
Last Name:MORTIMER-ORAGWU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 FM 1960 BYPASS RD E
Mailing Address - Street 2:SUITE 100 FAMILY PRACTICE DOCTORS P.A.
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3909
Mailing Address - Country:US
Mailing Address - Phone:281-570-2606
Mailing Address - Fax:208-570-2613
Practice Address - Street 1:1485 FM 1960 BYPASS RD E
Practice Address - Street 2:SUITE 100 FAMILY PRACTICE DOCTORS P.A.
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3909
Practice Address - Country:US
Practice Address - Phone:281-570-2606
Practice Address - Fax:208-570-2613
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039269Medicaid
CTD400005866 - C00023Medicare PIN
CTD400005863 - C00814Medicare PIN