Healthcare Provider Details

I. General information

NPI: 1033272745
Provider Name (Legal Business Name): IRENE C CAWI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 B SOUTH GRANT
ODESSA TX
79761
US

IV. Provider business mailing address

PO BOX 93
KERMIT TX
79745-0093
US

V. Phone/Fax

Practice location:
  • Phone: 432-580-7404
  • Fax: 432-580-7570
Mailing address:
  • Phone: 432-940-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number576611
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: