Provider Demographics
NPI:1780811265
Name:ERHUNMWUNSE, ROSELIN (OWNER)
Entity type:Individual
Prefix:
First Name:ROSELIN
Middle Name:
Last Name:ERHUNMWUNSE
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 SANDY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2902
Mailing Address - Country:US
Mailing Address - Phone:717-329-2123
Mailing Address - Fax:
Practice Address - Street 1:6610 HARWIN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2232
Practice Address - Country:US
Practice Address - Phone:713-320-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012044251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012044OtherTEXAS HOME HEALTH LICENSE