MEDICARE: EVBU-OSASU OSAWARU

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
1	363LW0102X	Women's Health Nurse Practitioner	AP116314	TX

General Provider Information

NPI Number	:	1336514066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVBU-OSASU OSAWARU

Provider Business Mailing Address
First Line	:	3815 CAVALCADE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-3403
Country	:	US
Telephone Number	:	713-673-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 CAVALCADE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-3403
Country	:	US
Telephone Number	:	713-673-1655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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