Provider Demographics
NPI:1306311774
Name:IMOUDU, FLORA ABIODUN
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:ABIODUN
Last Name:IMOUDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FLORA
Other - Middle Name:ABIODUN
Other - Last Name:IMOUDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AKINNAWONU
Mailing Address - Street 1:9637 FOREST LN APT 926
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-0923
Mailing Address - Country:US
Mailing Address - Phone:469-233-9889
Mailing Address - Fax:
Practice Address - Street 1:9637 FOREST LN APT 926
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-0923
Practice Address - Country:US
Practice Address - Phone:469-233-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332889164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse