Provider Demographics
NPI:1619470028
Name:IHUOMA, CANDICE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:IHUOMA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ALYSSA PALMS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4561
Mailing Address - Country:US
Mailing Address - Phone:832-741-6048
Mailing Address - Fax:
Practice Address - Street 1:2469 BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1519
Practice Address - Country:US
Practice Address - Phone:832-741-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily