MEDICARE: GODWN EMOBEFO OMIGIE

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	363L00000X	Nurse Practitioner	AP134957	TX

General Provider Information

NPI Number	:	1427576701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GODWN EMOBEFO OMIGIE

Provider Business Mailing Address
First Line	:	203 MENTOR DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-5435
Country	:	US
Telephone Number	:	817-262-3254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2261 BROOKHOLLOW PLAZA DR STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7417
Country	:	US
Telephone Number	:	832-967-8092
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	09/06/2017

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Directions to “ GODWN EMOBEFO OMIGIE ” Practice Location

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