MEDICARE: OMOYEME OBEAHON RN

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	680423	TX

General Provider Information

NPI Number	:	1588455570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMOYEME OBEAHON RN

Provider Business Mailing Address
First Line	:	6538 GREATWOOD PKWY UNIT B
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6312
Country	:	US
Telephone Number	:	832-613-8588
Fax Number	:	832-613-8588

Provider Business Practice Location Address
First Line	:	6538 GREATWOOD PKWY UNIT B
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6312
Country	:	US
Telephone Number	:	832-613-8588
Fax Number	:	832-613-8588

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

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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