Provider Demographics
NPI:1205349974
Name:NWOKEDI, EDWIN EZENWA (RN)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:EZENWA
Last Name:NWOKEDI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12809 FLAT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3105
Mailing Address - Country:US
Mailing Address - Phone:214-803-5452
Mailing Address - Fax:
Practice Address - Street 1:12809 FLAT CREEK DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3105
Practice Address - Country:US
Practice Address - Phone:214-803-5452
Practice Address - Fax:713-340-1252
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765829163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse