Provider Demographics
NPI:1013284132
Name:EHIMWONZEE, COURAGE OSA (RN)
Entity Type:Individual
Prefix:
First Name:COURAGE
Middle Name:OSA
Last Name:EHIMWONZEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 EGRET STREET
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181
Mailing Address - Country:US
Mailing Address - Phone:972-222-4125
Mailing Address - Fax:972-222-4125
Practice Address - Street 1:4601 EGRET ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4900
Practice Address - Country:US
Practice Address - Phone:972-222-4125
Practice Address - Fax:972-222-4125
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse