Healthcare Provider Details

I. General information

NPI: 1568172757
Provider Name (Legal Business Name): JULIET USIFOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 PIGEON HAWK DR
LITTLE ELM TX
75068-8589
US

IV. Provider business mailing address

1112 PIGEON HAWK DR
LITTLE ELM TX
75068-8589
US

V. Phone/Fax

Practice location:
  • Phone: 918-853-1976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number974912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: