Basic Information
| Provider Information | |||||||||
| NPI: | 1619417813 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ODOGBO | ||||||||
| FirstName: | EDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 W SAM HOUSTON PKWY N | ||||||||
| Address2: | STE 220 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770418224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134027824 | ||||||||
| FaxNumber: | 7135700196 | ||||||||
| Practice Location | |||||||||
| Address1: | 8307 KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132427707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2017 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP132423 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.