Provider Demographics
NPI:1639655954
Name:OSIFO, ANTHONIA OSATOHANMWEN (RN)
Entity Type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:OSATOHANMWEN
Last Name:OSIFO
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 1:15035 WESTPARK DR APT 319
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-3935
Mailing Address - Country:US
Mailing Address - Phone:713-530-6395
Mailing Address - Fax:
Practice Address - Street 1:247 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-7659
Practice Address - Country:US
Practice Address - Phone:936-756-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226071033163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health