MEDICARE: MICHAEL O DUNMOYE LVN

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	164X00000X	Licensed Vocational Nurse	225875	TX

General Provider Information

NPI Number	:	1770084089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL O DUNMOYE LVN

Provider Business Mailing Address
First Line	:	24758 GRAND HARBOR DR APT 2005
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0878
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24758 GRAND HARBOR DR APT 2005
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0878
Country	:	US
Telephone Number	:	832-420-1446
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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Directions to “ MICHAEL O DUNMOYE LVN” Practice Location

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