Provider Demographics
NPI:1457938979
Name:PROMEDICAL & WELLNESS PLLC
Entity Type:Organization
Organization Name:PROMEDICAL & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:LADOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:832-899-4353
Mailing Address - Street 1:11971 N GRAND PKWY E STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-1828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2212
Practice Address - Country:US
Practice Address - Phone:832-899-4353
Practice Address - Fax:832-899-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty