Provider Demographics
NPI:1407243025
Name:ODJIGHORO, GLADYS (RN)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:ODJIGHORO
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 1:10039 BISSONNET ST STE 109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7838
Mailing Address - Country:US
Mailing Address - Phone:832-831-7042
Mailing Address - Fax:281-436-6023
Practice Address - Street 1:10039 BISSONNET ST STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7838
Practice Address - Country:US
Practice Address - Phone:832-831-7042
Practice Address - Fax:281-436-6023
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX824484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse