Provider Demographics
NPI:1376221788
Name:ATSAFACK TIEUMO, OLIVE
Entity Type:Individual
Prefix:
First Name:OLIVE
Middle Name:
Last Name:ATSAFACK TIEUMO
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 1:14502 SUMMER CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6765
Mailing Address - Country:US
Mailing Address - Phone:832-874-3649
Mailing Address - Fax:
Practice Address - Street 1:7000 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5400
Practice Address - Country:US
Practice Address - Phone:713-500-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX978171163WM0705X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical