1821098054 NPI number — STELLA OSELGYAMFI GREEN FNP

Table of content: STELLA OSELGYAMFI GREEN FNP (NPI 1821098054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821098054 NPI number — STELLA OSELGYAMFI GREEN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
STELLA
Provider Middle Name:
OSELGYAMFI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GYAMFEI
Provider Other First Name:
STELLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821098054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 N HWY 360
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75050-2559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-602-3018
Provider Business Mailing Address Fax Number:
972-602-7337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 HWY 360
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
GRANDPRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-602-3018
Provider Business Practice Location Address Fax Number:
972-602-7337
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  676614 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150675006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150675005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150675003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150675007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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