Provider Demographics
NPI:1427203256
Name:AWOFODU, GRACE O (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:O
Last Name:AWOFODU
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 1:3730 AUBURN GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6807
Mailing Address - Country:US
Mailing Address - Phone:281-701-1700
Mailing Address - Fax:
Practice Address - Street 1:3730 AUBURN GROVE CIR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6807
Practice Address - Country:US
Practice Address - Phone:281-701-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
743165Medicare Oscar/Certification