Provider Demographics
NPI:1689257297
Name:AJITERU, PRISCILLA ADA (CNA)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ADA
Last Name:AJITERU
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 W SAM HOUSTON PKWY S APT 1601
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5065
Mailing Address - Country:US
Mailing Address - Phone:281-901-8856
Mailing Address - Fax:
Practice Address - Street 1:8565 W SAM HOUSTON PKWY S APT 1601
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5065
Practice Address - Country:US
Practice Address - Phone:281-901-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0060046617376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide