Provider Demographics
NPI:1679264717
Name:MADUFUR, HENRY
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:MADUFUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 SPINEL STONE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2859
Mailing Address - Country:US
Mailing Address - Phone:781-492-3174
Mailing Address - Fax:
Practice Address - Street 1:1606 SPINEL STONE CT
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-2859
Practice Address - Country:US
Practice Address - Phone:781-492-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant