Provider Demographics
NPI:1386019750
Name:IBE, PHILOMINA
Entity Type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:
Last Name:IBE
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 1:10811 SHANNON MILLS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4858
Mailing Address - Country:US
Mailing Address - Phone:713-987-9014
Mailing Address - Fax:
Practice Address - Street 1:5010 CRENSHAW RD STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4614
Practice Address - Country:US
Practice Address - Phone:832-399-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily