Provider Demographics
NPI:1376243857
Name:ADELE IDOWU, LATIFATU OMODOLAPO (PMHNP, MSN, RN)
Entity Type:Individual
Prefix:
First Name:LATIFATU
Middle Name:OMODOLAPO
Last Name:ADELE IDOWU
Suffix:
Gender:F
Credentials:PMHNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 SEA SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3319
Mailing Address - Country:US
Mailing Address - Phone:832-692-6909
Mailing Address - Fax:
Practice Address - Street 1:6100 CORPORATE DR STE 3A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3419
Practice Address - Country:US
Practice Address - Phone:832-831-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2022138648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health