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NPI Code Detail

MEDICARE: JUDITH G ONDIMU

MEDICARE:   JUDITH G ONDIMU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse329136TX

General Provider Information

NPI Number : 1003316696
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH G ONDIMU
Provider Business Mailing Address
First Line : 2345 ASH GROVE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-7430
Country : US
Telephone Number : 817-891-7862
Fax Number :
Provider Business Practice Location Address
First Line : 2345 ASH GROVE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-7430
Country : US
Telephone Number : 817-891-7862
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 02/20/2018

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