Healthcare Provider Details

I. General information

NPI: 1871342410
Provider Name (Legal Business Name): ABOSEDE ELIZABETH OGUNYEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 HIGHLAND WOODS WAY
MIDLOTHIAN TX
76065-7191
US

IV. Provider business mailing address

3715 HIGHLAND WOODS WAY
MIDLOTHIAN TX
76065-7191
US

V. Phone/Fax

Practice location:
  • Phone: 469-494-7311
  • Fax: --
Mailing address:
  • Phone: 469-494-7311
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: