Provider Demographics
NPI:1881991339
Name:OMOSEWO, JIDE (CRNA)
Entity type:Individual
Prefix:MR
First Name:JIDE
Middle Name:
Last Name:OMOSEWO
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1501 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2155
Mailing Address - Country:US
Mailing Address - Phone:361-573-6291
Mailing Address - Fax:361-576-2434
Practice Address - Street 1:1501 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2155
Practice Address - Country:US
Practice Address - Phone:361-573-6291
Practice Address - Fax:361-576-2434
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2021-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024169214367500000X
AZCRNA1477367500000X
TX869357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered