Provider Demographics
NPI:1073793733
Name:EFESOA, OTILIA F (RN,)
Entity Type:Individual
Prefix:
First Name:OTILIA
Middle Name:F
Last Name:EFESOA
Suffix:
Gender:F
Credentials:RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 CAYMUS CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3254
Mailing Address - Country:US
Mailing Address - Phone:972-219-9624
Mailing Address - Fax:
Practice Address - Street 1:1517 CAYMUS CT
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3254
Practice Address - Country:US
Practice Address - Phone:972-219-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management