Provider Demographics
NPI:1861388803
Name:NDUM, HENRIETTA T (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:T
Last Name:NDUM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13618 LAKEHILL PARK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7446
Mailing Address - Country:US
Mailing Address - Phone:832-969-4867
Mailing Address - Fax:
Practice Address - Street 1:13618 LAKEHILL PARK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7446
Practice Address - Country:US
Practice Address - Phone:832-969-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1197489363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health