Provider Demographics
NPI:1295213486
Name:EKANEM, UNYIME ASEYEN
Entity Type:Individual
Prefix:
First Name:UNYIME
Middle Name:ASEYEN
Last Name:EKANEM
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 1:13225 ROYAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-2860
Mailing Address - Country:US
Mailing Address - Phone:281-827-7539
Mailing Address - Fax:
Practice Address - Street 1:11929 UNIVERSITY BLVD STE 2M
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4757
Practice Address - Country:US
Practice Address - Phone:281-238-8775
Practice Address - Fax:281-491-7812
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209334163W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14025664OtherTEXAS DEPARTMENT OF SAFETY