Provider Demographics
NPI:1265958110
Name:GWANYEBIT-FODJE, MISIDA (NP)
Entity type:Individual
Prefix:
First Name:MISIDA
Middle Name:
Last Name:GWANYEBIT-FODJE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15006 WILDBERRY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2241
Mailing Address - Country:US
Mailing Address - Phone:949-294-3093
Mailing Address - Fax:
Practice Address - Street 1:18220 TEXAS 249 ACCESS ROAD
Practice Address - Street 2:230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-252-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133843363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology