Provider Demographics
NPI:1801441670
Name:WANORUE, CHRISTLE
Entity type:Individual
Prefix:
First Name:CHRISTLE
Middle Name:
Last Name:WANORUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMOGECHUKWU
Other - Middle Name:
Other - Last Name:UDEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24906 GRAND SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3224
Mailing Address - Country:US
Mailing Address - Phone:727-238-1174
Mailing Address - Fax:
Practice Address - Street 1:24906 GRAND SAPPHIRE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3224
Practice Address - Country:US
Practice Address - Phone:727-238-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX866038163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator