Provider Demographics
NPI:1720592801
Name:LEVY, BRENDA NWAOBASI (ACNPC-AG)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:NWAOBASI
Last Name:LEVY
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:ENYINNE
Other - Middle Name:NWAOBASI
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNPC-AG
Mailing Address - Street 1:722 BOLD RULER DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6355
Mailing Address - Country:US
Mailing Address - Phone:832-573-1140
Mailing Address - Fax:
Practice Address - Street 1:7600 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4302
Practice Address - Country:US
Practice Address - Phone:832-573-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135796363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP135796OtherTEXAS BOARD OF NURSES- ACUTE CARE NURSE PRACTITIONER