Provider Demographics
NPI:1801392170
Name:WODI, AUGUSTA NGOZI
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:NGOZI
Last Name:WODI
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 1:511 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4206
Mailing Address - Country:US
Mailing Address - Phone:469-328-2721
Mailing Address - Fax:
Practice Address - Street 1:511 POPLAR LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4206
Practice Address - Country:US
Practice Address - Phone:469-328-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty