Provider Demographics
NPI:1326639667
Name:OSAKEDE, BENEDICTA DORA
Entity Type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:DORA
Last Name:OSAKEDE
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 1:7762 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2700
Mailing Address - Country:US
Mailing Address - Phone:702-326-0207
Mailing Address - Fax:
Practice Address - Street 1:7762 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2700
Practice Address - Country:US
Practice Address - Phone:702-326-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant