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General NPI Number Information
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NPI Number | 1669986196
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Entity Type | Individual
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Provider Name | OMOBOLA ABOSEDE PETINRIN FNP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1225 FARR ST
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City | WALLER
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State | TX
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Zip | 77484-8486
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Country | US
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Telephone | 936-372-3003
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Fax | 936-372-8070
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Provider Business Mailing Address
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Address Line | 12822 SHADOW CANYON LN
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City | PEARLAND
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State | TX
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Zip | 77584-3640
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Country | US
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Telephone | 646-441-0897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP134723
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License Number State | TX
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