Provider Demographics
NPI:1285748079
Name:OTALOR, PATRICIA ONYEMA (BSN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ONYEMA
Last Name:OTALOR
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 GRAND PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:281-630-7269
Mailing Address - Fax:
Practice Address - Street 1:4014 GRAND PLANTATION LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2384
Practice Address - Country:US
Practice Address - Phone:281-630-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610785163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse