Provider Demographics
NPI:1023674710
Name:ODOEMENA, LOVE EBERE
Entity type:Individual
Prefix:
First Name:LOVE
Middle Name:EBERE
Last Name:ODOEMENA
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 1:1216 CATHEY ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8150
Mailing Address - Country:US
Mailing Address - Phone:214-962-4422
Mailing Address - Fax:
Practice Address - Street 1:1216 CATHEY ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-8150
Practice Address - Country:US
Practice Address - Phone:214-962-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329352164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse