Provider Demographics
NPI:1780189241
Name:IBEKWE, ADELINE CHINWE
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:CHINWE
Last Name:IBEKWE
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 1:14323 MOSSY GATE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2160
Mailing Address - Country:US
Mailing Address - Phone:832-638-0556
Mailing Address - Fax:
Practice Address - Street 1:14323 MOSSY GATE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2160
Practice Address - Country:US
Practice Address - Phone:832-638-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222426164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse