Provider Demographics
NPI:1932855731
Name:EZENNIA, LINDA C
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:EZENNIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 BLUE CANOE RD
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1619
Mailing Address - Country:US
Mailing Address - Phone:281-995-0641
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 525
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2691
Practice Address - Country:US
Practice Address - Phone:832-378-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health