MEDICARE: VIVIAN ODOEMENEM FNP

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	AP133142	TX

General Provider Information

NPI Number	:	1972044824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN ODOEMENEM FNP

Provider Business Mailing Address
First Line	:	PO BOX 3345
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77253-3345
Country	:	US
Telephone Number	:	713-796-9955
Fax Number	:

Provider Business Practice Location Address
First Line	:	7926 SHADOW DANCE LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-6413
Country	:	US
Telephone Number	:	346-298-3923
Fax Number	:

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

Provider Enumeration Date	:	03/11/2017
Last Update Date	:	06/10/2026

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