MEDICARE: PAULINE CHIDIEBERE ODILI

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP129325	TX
2	363LF0000X	Family Nurse Practitioner	AP129325	TX

General Provider Information

NPI Number	:	1669845517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE CHIDIEBERE ODILI

Provider Business Mailing Address
First Line	:	8406 SPOTSLYVANIA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6434
Country	:	US
Telephone Number	:	832-495-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	8406 SPOTSLYVANIA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6434
Country	:	US
Telephone Number	:	832-495-3006
Fax Number	:

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

Provider Enumeration Date	:	10/31/2015
Last Update Date	:	12/12/2018

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Directions to “ PAULINE CHIDIEBERE ODILI ” Practice Location

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