Provider Demographics
NPI:1750864468
Name:OMIDIWURA, CATHERINE O (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:O
Last Name:OMIDIWURA
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 1:20114 WINDYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4595
Mailing Address - Country:US
Mailing Address - Phone:936-668-8281
Mailing Address - Fax:
Practice Address - Street 1:20114 WINDYSTONE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4595
Practice Address - Country:US
Practice Address - Phone:936-668-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX952669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse