Provider Demographics
NPI:1700966579
Name:UDEOBONG, ALICE ITA
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:ITA
Last Name:UDEOBONG
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 1:7402 PAVILION DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6927
Mailing Address - Country:US
Mailing Address - Phone:832-886-4539
Mailing Address - Fax:832-886-4690
Practice Address - Street 1:7402 PAVILION DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6927
Practice Address - Country:US
Practice Address - Phone:832-886-4539
Practice Address - Fax:832-886-4690
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9809390200000X
TX011219163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9809OtherCHES