Provider Demographics
NPI:1508378514
Name:ODEGAI, NDUBUISI ALVIN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:NDUBUISI
Middle Name:ALVIN
Last Name:ODEGAI
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5534
Mailing Address - Country:US
Mailing Address - Phone:972-483-5380
Mailing Address - Fax:972-217-4773
Practice Address - Street 1:703 S HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-5534
Practice Address - Country:US
Practice Address - Phone:972-483-5380
Practice Address - Fax:972-217-4773
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61155363LP0808X
TXAP135646363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty