Provider Demographics
NPI:1922318344
Name:ELEGE, VIVIAN NGOZI
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:NGOZI
Last Name:ELEGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16325 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1233
Mailing Address - Country:US
Mailing Address - Phone:713-820-3543
Mailing Address - Fax:832-451-6898
Practice Address - Street 1:16325 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1233
Practice Address - Country:US
Practice Address - Phone:346-270-3648
Practice Address - Fax:713-804-9443
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128980363LP0808X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily