Provider Demographics
NPI:1790342723
Name:NDUKWE, NELLY K (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:K
Last Name:NDUKWE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19142
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-9142
Mailing Address - Country:US
Mailing Address - Phone:832-875-5459
Mailing Address - Fax:
Practice Address - Street 1:5200 POINTE WEST CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2215
Practice Address - Country:US
Practice Address - Phone:832-875-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily