Provider Demographics
NPI:1447719802
Name:KOUAMOU KOUANGOUA, ELODIE
Entity type:Individual
Prefix:
First Name:ELODIE
Middle Name:
Last Name:KOUAMOU KOUANGOUA
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 1:7909 S SAM HOUSTON PKWY E APT 626
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4793
Mailing Address - Country:US
Mailing Address - Phone:281-777-7850
Mailing Address - Fax:
Practice Address - Street 1:7909 S SAM HOUSTON PKWY E APT 626
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4793
Practice Address - Country:US
Practice Address - Phone:281-777-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942722163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse