Provider Demographics
NPI:1457848830
Name:OGODO, SOPHIE (LVN)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:OGODO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FIRWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8913
Mailing Address - Country:US
Mailing Address - Phone:469-274-2495
Mailing Address - Fax:
Practice Address - Street 1:350 FIRWOOD PL
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8913
Practice Address - Country:US
Practice Address - Phone:469-274-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317406164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty