Provider Demographics
NPI:1205392123
Name:MADU-FATOKI, TINUKE NNENNA
Entity Type:Individual
Prefix:
First Name:TINUKE
Middle Name:NNENNA
Last Name:MADU-FATOKI
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 1:3354 ROGERDALE RD APT 826
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-5039
Mailing Address - Country:US
Mailing Address - Phone:832-597-5877
Mailing Address - Fax:
Practice Address - Street 1:3354 ROGERDALE RD APT 826
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-5039
Practice Address - Country:US
Practice Address - Phone:832-597-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX927644163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics