Individual
MRS. ANN CHIOMA AGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
719144
TX
363LF0000X
Family Nurse Practitioner
Primary
AP126056
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00106W
MDCR GRP PTAN #
TX
01
—
0035TD
BCBSTX GRP PROV RECORD #
TX
01
—
153449704
MDCD GRP TPI #
TX
05
—
343114002 (MDACC)
—
TX
01
—
387035YNBT
INDIV MDCR PTAN
TX
Enumeration date
11/03/2014
Last updated
09/23/2015
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