Provider Demographics
NPI:1710355839
Name:IJOMAH, VIVIEN ANWULI (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:ANWULI
Last Name:IJOMAH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 MAHOGANY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-0946
Mailing Address - Country:US
Mailing Address - Phone:469-879-2707
Mailing Address - Fax:
Practice Address - Street 1:1590 MAHOGANY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-0946
Practice Address - Country:US
Practice Address - Phone:469-879-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731760163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management