Provider Demographics
NPI:1831672971
Name:DECLAN, EDITH NKEM (FNP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:NKEM
Last Name:DECLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EDTH
Other - Middle Name:NKEM
Other - Last Name:NWOBODO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:826 LA HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2859
Mailing Address - Country:US
Mailing Address - Phone:713-909-6541
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:713-666-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931021163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology