MEDICARE: ENOS ODEDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	777392	TX
2	163WG0000X	General Practice Registered Nurse	777392	TX
3	374U00000X	Home Health Aide	777392	TX

General Provider Information

NPI Number	:	1245695477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENOS ODEDE

Provider Business Mailing Address
First Line	:	3773 TIMBERGLEN RD APT 805
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3719
Country	:	US
Telephone Number	:	214-862-2951
Fax Number	:

Provider Business Practice Location Address
First Line	:	3773 TIMBERGLEN RD APT 805
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3719
Country	:	US
Telephone Number	:	214-862-2951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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Directions to “ ENOS ODEDE ” Practice Location

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