Provider Demographics
NPI:1467946178
Name:NWAKANMA, SYLVIA UDOKORO
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:UDOKORO
Last Name:NWAKANMA
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 1:5422 STREAMSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2222
Mailing Address - Country:US
Mailing Address - Phone:678-446-4298
Mailing Address - Fax:587-200-1005
Practice Address - Street 1:1601 LIBERTY ST STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3252
Practice Address - Country:US
Practice Address - Phone:832-449-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013057363LF0000X, 363LP2300X
MARN2351612363LF0000X
TXAP145089363LP0808X, 363LP2300X, 363LF0000X
GARN204569363LP2300X, 363LF0000X
WA61070744363LF0000X, 363LP2300X
FLTPAN48363LP2300X
AZ243831363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty