Provider Demographics
NPI:1174089874
Name:UTUBOR, PHILOMENA
Entity type:Individual
Prefix:MRS
First Name:PHILOMENA
Middle Name:
Last Name:UTUBOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PHILOMENA
Other - Middle Name:
Other - Last Name:UTUBOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:429 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5327
Mailing Address - Country:US
Mailing Address - Phone:817-899-1141
Mailing Address - Fax:
Practice Address - Street 1:429 TRINITY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5327
Practice Address - Country:US
Practice Address - Phone:817-899-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily