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Individual

ELO EDITH OMAKOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
215 DALTON DR, DESOTO, TX 75115-4454
(682) 272-5143
Mailing address
PO BOX 1805, MANSFIELD, TX 76063-0017
(682) 272-5143
(972) 440-2057

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
847722
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP135575
TX

Other

Enumeration date
10/24/2017
Last updated
04/11/2022
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