Provider Demographics
NPI:1942702287
Name:EZEM, GLADYS CHIDIEBERE (RN)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:CHIDIEBERE
Last Name:EZEM
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 1:14458 ANDREA WAY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-7712
Mailing Address - Country:US
Mailing Address - Phone:832-762-7348
Mailing Address - Fax:
Practice Address - Street 1:14458 ANDREA WAY LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7712
Practice Address - Country:US
Practice Address - Phone:832-762-7348
Practice Address - Fax:832-672-5872
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
TX835691163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management