Provider Demographics
NPI:1902684061
Name:ODIASE, JOHN OSAMUYIMEN (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OSAMUYIMEN
Last Name:ODIASE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 SQUARE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1679
Mailing Address - Country:US
Mailing Address - Phone:909-667-6885
Mailing Address - Fax:
Practice Address - Street 1:25700 INTERSTATE 45 N STE 440
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1967
Practice Address - Country:US
Practice Address - Phone:281-651-2268
Practice Address - Fax:281-918-4736
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039109163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health