Provider Demographics
NPI:1912337668
Name:NWANA, OLA-EDO YVONNE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:OLA-EDO
Middle Name:YVONNE
Last Name:NWANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:OLA-EDO
Other - Middle Name:
Other - Last Name:ORJIAKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21720 KINGSLAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-579-5555
Mailing Address - Fax:
Practice Address - Street 1:21720 KINGSLAND BLVD.
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-579-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2017-10-30
Deactivation Date:2014-05-20
Deactivation Code:
Reactivation Date:2017-10-30
Provider Licenses
StateLicense IDTaxonomies
TX37665103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist