Provider Demographics
NPI:1780461145
Name:OTOMEWO, GLORIA E
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:E
Last Name:OTOMEWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-2112
Mailing Address - Country:US
Mailing Address - Phone:469-753-2328
Mailing Address - Fax:
Practice Address - Street 1:5208 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-2112
Practice Address - Country:US
Practice Address - Phone:469-753-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse