Provider Demographics
NPI:1780862821
Name:OKPALA, MUNACHI N (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MUNACHI
Middle Name:N
Last Name:OKPALA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MUNACHI
Other - Middle Name:N
Other - Last Name:ONYEDEBELU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-C,MBA, DNP-C
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:1014
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7473
Mailing Address - Fax:713-512-2239
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-500-7473
Practice Address - Fax:713-512-2239
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670841363LF0000X
TX008629251E00000X
673140251E00000X
TX170163302332B00000X
4740620001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00103111Medicaid
TX170163302Medicaid
TX001013111Medicaid
TX170163304Medicaid
TX1701633-04Medicaid
TX00103111Medicaid