Provider Demographics
NPI:1548981749
Name:ISIDAHOMEN, ENE
Entity type:Individual
Prefix:
First Name:ENE
Middle Name:
Last Name:ISIDAHOMEN
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 1:15210 SUMMER BOUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6603
Mailing Address - Country:US
Mailing Address - Phone:832-857-3040
Mailing Address - Fax:
Practice Address - Street 1:8727 W RAYFORD RD STE 160
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-5440
Practice Address - Country:US
Practice Address - Phone:281-547-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNONE