Provider Demographics
NPI:1295461986
Name:MBONU, CHINWE MAUREEN (NP)
Entity Type:Individual
Prefix:
First Name:CHINWE
Middle Name:MAUREEN
Last Name:MBONU
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 1:6226 PROVIDENT GREEN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2059
Mailing Address - Country:US
Mailing Address - Phone:832-880-5743
Mailing Address - Fax:
Practice Address - Street 1:4345 PHELAN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2157
Practice Address - Country:US
Practice Address - Phone:832-880-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health