Provider Demographics
NPI:1417541194
Name:EGBE-TAMBE, NNENE NCHACK
Entity Type:Individual
Prefix:
First Name:NNENE
Middle Name:NCHACK
Last Name:EGBE-TAMBE
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 1:2656 S LOOP W STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5632
Mailing Address - Country:US
Mailing Address - Phone:512-659-2728
Mailing Address - Fax:
Practice Address - Street 1:5560 MESA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2120
Practice Address - Country:US
Practice Address - Phone:682-477-3534
Practice Address - Fax:682-477-3602
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030646363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health