Provider Demographics
NPI:1982910352
Name:OMOIRAWUA, ESEOSA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ESEOSA
Middle Name:
Last Name:OMOIRAWUA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 EVERGREEN AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4518
Mailing Address - Country:US
Mailing Address - Phone:718-893-4407
Mailing Address - Fax:
Practice Address - Street 1:955 EVERGREEN AVE APT 201
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4518
Practice Address - Country:US
Practice Address - Phone:718-893-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594604-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse