Provider Demographics
NPI:1891296877
Name:OMEZI, CELINE
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:OMEZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 FERGUSON RD APT 1421
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7636
Mailing Address - Country:US
Mailing Address - Phone:469-261-3736
Mailing Address - Fax:
Practice Address - Street 1:11611 FERGUSON RD APT 1421
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7636
Practice Address - Country:US
Practice Address - Phone:469-261-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse