MEDICARE: DESSENCE HEALTHCARE SERVICES INC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1659044469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESSENCE HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	6112 N MESA ST # 6102
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4516
Country	:	US
Telephone Number	:	915-243-4248
Fax Number	:

Provider Business Practice Location Address
First Line	:	6112 N MESA ST # 6102
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4516
Country	:	US
Telephone Number	:	915-243-4248
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. PAMELA O OGBONNA
Credential	:	DNP
Telephone Number	:	915-243-4248

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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