Provider Demographics
NPI:1790207835
Name:AIHEVBA, EUNICE OSARENMWINHIA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:OSARENMWINHIA
Last Name:AIHEVBA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28003 YELLOW CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5757
Mailing Address - Country:US
Mailing Address - Phone:504-756-1983
Mailing Address - Fax:
Practice Address - Street 1:4657 OCEAN DR APT 205
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2664
Practice Address - Country:US
Practice Address - Phone:504-756-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered