Provider Demographics
NPI:1891017406
Name:NWOKORIE, STELLA NGOZI (RN)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:NGOZI
Last Name:NWOKORIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 UZOR STREET
Mailing Address - Street 2:
Mailing Address - City:AJEGUNLE APAPA
Mailing Address - State:YORUBA
Mailing Address - Zip Code:4262
Mailing Address - Country:NG
Mailing Address - Phone:713-530-3336
Mailing Address - Fax:
Practice Address - Street 1:11802 PEDERNALES FALLS LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4623
Practice Address - Country:US
Practice Address - Phone:713-530-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$4110664Medicaid