Provider Demographics
NPI:1134867054
Name:IWUOZO, BLESSING
Entity type:Individual
Prefix:
First Name:BLESSING
Middle Name:
Last Name:IWUOZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLESSING
Other - Middle Name:ODINAKA
Other - Last Name:EKWURIBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1636 HUNTERS GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5008
Mailing Address - Country:US
Mailing Address - Phone:423-557-9602
Mailing Address - Fax:
Practice Address - Street 1:1636 HUNTERS GLEN RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5008
Practice Address - Country:US
Practice Address - Phone:423-557-9602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034069163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse