Provider Demographics
NPI:1609499516
Name:GLOW MAVEN
Entity Type:Organization
Organization Name:GLOW MAVEN
Other - Org Name:GLOW MAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAKU
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:IWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP-BC
Authorized Official - Phone:832-600-4515
Mailing Address - Street 1:4544 POST OAK PLACE DR STE 254
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3104
Mailing Address - Country:US
Mailing Address - Phone:832-600-4515
Mailing Address - Fax:
Practice Address - Street 1:4544 POST OAK PLACE DR STE 254
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3104
Practice Address - Country:US
Practice Address - Phone:832-600-4515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty