Provider Demographics
NPI:1992207930
Name:NNABUIKE, FANNY EGBE (FNP)
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:EGBE
Last Name:NNABUIKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:FANNY
Other - Middle Name:EGBE
Other - Last Name:TANYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN,MSN,APRN,FNP
Mailing Address - Street 1:11665 HIGHWAY 6 SOUTH, SUGARLAND TEXAS
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:713-909-0407
Mailing Address - Fax:
Practice Address - Street 1:6315 GULFTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-445-7372
Practice Address - Fax:713-457-0945
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10171122163WG0000X
TXAP136186363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily