Provider Demographics
NPI:1649772641
Name:EGEGE, UGONMA
Entity Type:Individual
Prefix:
First Name:UGONMA
Middle Name:
Last Name:EGEGE
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 1:715 VALLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4992
Mailing Address - Country:US
Mailing Address - Phone:832-880-3884
Mailing Address - Fax:
Practice Address - Street 1:3315 MARQUART ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6000
Practice Address - Country:US
Practice Address - Phone:713-799-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665235163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse