Healthcare Provider Details

I. General information

NPI: 1457729287
Provider Name (Legal Business Name): DORIS ADEDIWURA OBAZE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15415 WAUMSLEY WAY
SUGAR LAND TX
77498-7573
US

IV. Provider business mailing address

15415 WAUMSLEY WAY
SUGAR LAND TX
77498-7573
US

V. Phone/Fax

Practice location:
  • Phone: 713-205-7328
  • Fax: 713-777-5034
Mailing address:
  • Phone: 713-205-7328
  • Fax: 713-777-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: