Provider Demographics
NPI:1437412764
Name:IYAMU, OSARU (LVN)
Entity Type:Individual
Prefix:MISS
First Name:OSARU
Middle Name:
Last Name:IYAMU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MORRISS RD
Mailing Address - Street 2:APT 225
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1853
Mailing Address - Country:US
Mailing Address - Phone:469-583-6218
Mailing Address - Fax:
Practice Address - Street 1:4100 MORRISS RD
Practice Address - Street 2:APT 225
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1853
Practice Address - Country:US
Practice Address - Phone:469-583-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222235164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX222235OtherTEXAS BOARD OF NURSING