Provider Demographics
NPI:1417577073
Name:PAUL, CHRISTABEL OMOLOLA
Entity Type:Individual
Prefix:
First Name:CHRISTABEL
Middle Name:OMOLOLA
Last Name:PAUL
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 1:7344 PARKRIDGE BLVD APT 497
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8259
Mailing Address - Country:US
Mailing Address - Phone:682-597-6094
Mailing Address - Fax:
Practice Address - Street 1:7344 PARKRIDGE BLVD APT 497
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-8259
Practice Address - Country:US
Practice Address - Phone:682-597-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX726276163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse