Provider Demographics
NPI:1740985563
Name:NSIAGWAI, IFEANYI MAXWELL
Entity type:Individual
Prefix:
First Name:IFEANYI
Middle Name:MAXWELL
Last Name:NSIAGWAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 STATE HIGHWAY 249 STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1132
Mailing Address - Country:US
Mailing Address - Phone:409-540-7220
Mailing Address - Fax:
Practice Address - Street 1:17350 STATE HIGHWAY 249 STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1132
Practice Address - Country:US
Practice Address - Phone:409-540-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)