Basic Information
| Provider Information | |||||||||
| NPI: | 1962939132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSEMWOTA | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | OVBIYE | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16605 SOUTHWEST FWY STE 175 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774790003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813025645 | ||||||||
| FaxNumber: | 7134295207 | ||||||||
| Practice Location | |||||||||
| Address1: | 16605 SOUTHWEST FWY STE 175 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774790003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813025645 | ||||||||
| FaxNumber: | 7134295207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP132638 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 45-0675246 | 01 | TX | MEDICARE, MEDICAID, PRIVATE INSURANCE | OTHER |