Provider Demographics
NPI:1447504477
Name:IWUNDU, EDNA C
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:C
Last Name:IWUNDU
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 1:12518 BERRY LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2445
Mailing Address - Country:US
Mailing Address - Phone:832-633-8139
Mailing Address - Fax:281-440-6867
Practice Address - Street 1:12518 BERRY LAUREL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2445
Practice Address - Country:US
Practice Address - Phone:832-633-8139
Practice Address - Fax:281-440-6867
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320493326OtherIRS