Provider Demographics
NPI:1497247605
Name:AGBO, ODUMEGWU STEVE
Entity Type:Individual
Prefix:
First Name:ODUMEGWU
Middle Name:STEVE
Last Name:AGBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 SYNOTT RD APT 1113
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5235
Mailing Address - Country:US
Mailing Address - Phone:832-891-9937
Mailing Address - Fax:
Practice Address - Street 1:3939 SYNOTT RD APT 1113
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5235
Practice Address - Country:US
Practice Address - Phone:832-891-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX882398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse