Provider Demographics
NPI:1184106684
Name:OHENZUWA, GLADYS
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:OHENZUWA
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 1:19915 LAUREL TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1061
Mailing Address - Country:US
Mailing Address - Phone:281-250-4212
Mailing Address - Fax:
Practice Address - Street 1:16320 MELLOW OAKS LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7214
Practice Address - Country:US
Practice Address - Phone:713-702-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212304164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse