Provider Demographics
NPI:1023585809
Name:OSEMWENGIE, OSAZE KEN
Entity type:Individual
Prefix:
First Name:OSAZE
Middle Name:KEN
Last Name:OSEMWENGIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 CEDAR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2818
Mailing Address - Country:US
Mailing Address - Phone:817-946-3318
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7361
Practice Address - Country:US
Practice Address - Phone:817-946-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily