Provider Demographics
NPI:1609499516
Name:GLOW MAVEN LLC
Entity type:Organization
Organization Name:GLOW MAVEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAKU
Authorized Official - Middle Name:
Authorized Official - Last Name:IWU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:832-600-4515
Mailing Address - Street 1:5909 WEST LOOP S FWY SVC RD
Mailing Address - Street 2:SUITE 670
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3104
Mailing Address - Country:US
Mailing Address - Phone:346-335-7354
Mailing Address - Fax:866-281-8995
Practice Address - Street 1:5909 WEST LOOP S FWY SVC RD
Practice Address - Street 2:SUITE 670
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3104
Practice Address - Country:US
Practice Address - Phone:346-335-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty