Provider Demographics
NPI:1760013924
Name:MBAGWU, NGOZI JOSEPHINE
Entity type:Individual
Prefix:MRS
First Name:NGOZI
Middle Name:JOSEPHINE
Last Name:MBAGWU
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 1:2123 LAUREL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2468
Mailing Address - Country:US
Mailing Address - Phone:832-982-4495
Mailing Address - Fax:
Practice Address - Street 1:2123 LAUREL CREEK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2468
Practice Address - Country:US
Practice Address - Phone:832-982-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily