Provider Demographics
NPI:1780946608
Name:IDOWU, QUEEN
Entity type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:IDOWU
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 1:8215 HAWTHORN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1469
Mailing Address - Country:US
Mailing Address - Phone:281-829-8314
Mailing Address - Fax:210-446-5084
Practice Address - Street 1:8215 HAWTHORN VALLEY LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1469
Practice Address - Country:US
Practice Address - Phone:281-829-8314
Practice Address - Fax:210-446-5084
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016904363LA2200X, 363LP0808X
WAAP61235096363LA2200X, 363LP0808X
FL11015344363LA2200X
NMCNP03043363LA2200X, 363LP0808X
TXAP121706363LA2200X, 363LG0600X, 363LP0808X
OR202201930NP363LA2200X
OR202201930NP-PP363LP0808X
FLAPRN11015344363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304306901Medicaid
TX304306901Medicaid