MEDICARE: MRS. ELSIE C.O IFEDIORA REGISTERED NURSE

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	163W00000X	Registered Nurse	624718	TX

General Provider Information

NPI Number	:	1457836538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELSIE C.O IFEDIORA REGISTERED NURSE

Provider Business Mailing Address
First Line	:	103 GLENWOOD DR
Second Line	:
City	:	MURPHY
State	:	TX
Zip	:	75094-3446
Country	:	US
Telephone Number	:	214-938-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 GLENWOOD DR
Second Line	:
City	:	MURPHY
State	:	TX
Zip	:	75094-3446
Country	:	US
Telephone Number	:	214-938-0809
Fax Number	:

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

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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