Provider Demographics
NPI:1336514066
Name:OSAWARU, EVBU-OSASU
Entity Type:Individual
Prefix:
First Name:EVBU-OSASU
Middle Name:
Last Name:OSAWARU
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 1:3815 CAVALCADE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-3403
Mailing Address - Country:US
Mailing Address - Phone:713-673-1655
Mailing Address - Fax:
Practice Address - Street 1:3815 CAVALCADE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-3403
Practice Address - Country:US
Practice Address - Phone:713-673-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116314363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health