Provider Demographics
NPI:1801520804
Name:IHAZA, IFEOLUWA (APRN)
Entity type:Individual
Prefix:
First Name:IFEOLUWA
Middle Name:
Last Name:IHAZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:IFEOLUWA
Other - Middle Name:TOKUNBO
Other - Last Name:IHAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:8080 N STADIUM DR STE 180
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8080 N STADIUM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1829
Practice Address - Country:US
Practice Address - Phone:832-822-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076892363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health