Provider Demographics
NPI:1811794084
Name:MADUEKWE, DEBRA EJIRO (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:EJIRO
Last Name:MADUEKWE
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:EJIRO
Other - Last Name:ACHOJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3634 GLENN LAKES LN STE 198
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3634 GLENN LAKES LN STE 198
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4062
Practice Address - Country:US
Practice Address - Phone:281-710-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070924363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health