MEDICARE: HATSHEPSUT MBOLUJI OSHUN PA

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	363A00000X	Physician Assistant	PA08286	TX

General Provider Information

NPI Number	:	1346587854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HATSHEPSUT MBOLUJI OSHUN PA

Provider Business Mailing Address
First Line	:	5533 MATALEE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 OLD NORTH RD STE 101
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-1524
Country	:	US
Telephone Number	:	940-387-5800
Fax Number	:

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

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	03/17/2018

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