MEDICARE: ADAEZE PEACE OBI

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	163WP0200X	Pediatric Registered Nurse	956698	TX

General Provider Information

NPI Number	:	1962062802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAEZE PEACE OBI

Provider Business Mailing Address
First Line	:	13100 W BELLFORT AVE APT 417
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4833
Country	:	US
Telephone Number	:	832-651-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	13100 W BELLFORT AVE APT 417
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4833
Country	:	US
Telephone Number	:	832-651-5843
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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Directions to “ ADAEZE PEACE OBI ” Practice Location

Language	Start Address	Practice Location

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