Basic Information
| Provider Information | |||||||||
| NPI: | 1609435502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGWIM | ||||||||
| FirstName: | CORDELIA | ||||||||
| MiddleName: | OGECHI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15023 SIERRA SUNSET DR | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773964265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133844998 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 CYPRESS STATION DRIVE #270 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322531188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP141771 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.