Provider Demographics
NPI:1972853166
Name:IVORY FAMILY HEALTH & WELLNESS CLINIC INC
Entity Type:Organization
Organization Name:IVORY FAMILY HEALTH & WELLNESS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:OSITADINMA
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-649-3967
Mailing Address - Street 1:7457 HARWIN DR STE 133
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2023
Mailing Address - Country:US
Mailing Address - Phone:832-649-3967
Mailing Address - Fax:
Practice Address - Street 1:7457 HARWIN DR STE 133
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2023
Practice Address - Country:US
Practice Address - Phone:832-649-3967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty