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NPI Code Detail

MEDICARE: MARY OGUNDIRAN

MEDICARE:   MARY  OGUNDIRAN
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
1363LF0000XFamily Nurse PractitionerAP126614TX

General Provider Information

NPI Number : 1770981169
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY OGUNDIRAN
Provider Business Mailing Address
First Line : 13411 MOONLIT LAKE LN
Second Line : APT 502
City : PEARLAND
State : TX
Zip : 77584-3734
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9850 EMMETT F LOWRY EXPY
Second Line :
City : TEXAS CITY
State : TX
Zip : 77591-2000
Country : US
Telephone Number : 409-938-2230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2014
Last Update Date : 01/29/2016

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Directions to “ MARY OGUNDIRAN ” Practice Location

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