Provider Demographics
NPI:1720679913
Name:IBE, JUSTINA NNEDIMMA
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:NNEDIMMA
Last Name:IBE
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 1:7514 KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4412
Mailing Address - Country:US
Mailing Address - Phone:713-644-8393
Mailing Address - Fax:713-644-0490
Practice Address - Street 1:7514 KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4412
Practice Address - Country:US
Practice Address - Phone:713-644-8393
Practice Address - Fax:713-644-0490
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner