Provider Demographics
NPI:1548691827
Name:EGBONWONU, KENYA (RN)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:EGBONWONU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 FM 1960 RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1886
Mailing Address - Country:US
Mailing Address - Phone:832-764-9108
Mailing Address - Fax:821-443-7236
Practice Address - Street 1:324 FM 1960 RD
Practice Address - Street 2:SUITE 109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1886
Practice Address - Country:US
Practice Address - Phone:832-764-9108
Practice Address - Fax:821-443-7236
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX719090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse