Healthcare Provider Details

I. General information

NPI: 1255649596
Provider Name (Legal Business Name): OMOSEDE UWAIFO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5718 WESTHEIMER RD FL 4
HOUSTON TX
77057-5745
US

IV. Provider business mailing address

5718 WESTHEIMER RD STE 400
HOUSTON TX
77057-5733
US

V. Phone/Fax

Practice location:
  • Phone: 917-214-9997
  • Fax: 281-895-3083
Mailing address:
  • Phone: 917-214-9997
  • Fax: 281-895-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number632814
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345337
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: