Provider Demographics
NPI:1053055541
Name:OPTIMUM HOUSECALL PROVIDERS PLLC
Entity Type:Organization
Organization Name:OPTIMUM HOUSECALL PROVIDERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMITILLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:972-821-2354
Mailing Address - Street 1:1058 MOCKINGBIRD HILL CT
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3255
Mailing Address - Country:US
Mailing Address - Phone:972-821-2354
Mailing Address - Fax:
Practice Address - Street 1:1058 MOCKINGBIRD HILL CT
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-3255
Practice Address - Country:US
Practice Address - Phone:972-821-2354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty