Provider Demographics
NPI:1245712413
Name:UDOBONG, VERONICA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:UDOBONG
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 1:13814 CHERRY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-3308
Mailing Address - Country:US
Mailing Address - Phone:281-687-9640
Mailing Address - Fax:
Practice Address - Street 1:13814 CHERRY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-3308
Practice Address - Country:US
Practice Address - Phone:281-687-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918580163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health