Provider Demographics
NPI:1841535564
Name:NWAHIRI, VIVIAN IJEOMA (ANP)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:IJEOMA
Last Name:NWAHIRI
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:IJEOMA
Other - Last Name:NWAHIRI-CHIMEZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1200 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:281-516-1505
Mailing Address - Fax:
Practice Address - Street 1:1200 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-516-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012010799363L00000X, 363LA2200X, 363LP2300X
TX1048245363L00000X, 363LA2200X
KS5375672061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care