Provider Demographics
NPI:1215412036
Name:OJEBODE, GRACE TEMITOPE (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:TEMITOPE
Last Name:OJEBODE
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 1:2626 BABCOCK RD APT 2610
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4841
Mailing Address - Country:US
Mailing Address - Phone:214-930-0331
Mailing Address - Fax:
Practice Address - Street 1:2626 BABCOCK RD APT 2610
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4841
Practice Address - Country:US
Practice Address - Phone:214-930-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942536163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics