Provider Demographics
NPI:1265218184
Name:UDOFIA, SAMUEL (RN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:UDOFIA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 SUN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-7389
Mailing Address - Country:US
Mailing Address - Phone:281-965-4616
Mailing Address - Fax:
Practice Address - Street 1:7111 SUN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7389
Practice Address - Country:US
Practice Address - Phone:281-965-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907467163WG0000X, 163WH0200X, 163WM0705X, 163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation