Provider Demographics
NPI:1386939429
Name:OSEVWE, EDEWOR BERNAED (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:EDEWOR
Middle Name:BERNAED
Last Name:OSEVWE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:MR
Other - First Name:EDEWOR
Other - Middle Name:BERNARD
Other - Last Name:OSEVWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP BEN
Mailing Address - Street 1:6302 BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7859
Mailing Address - Country:US
Mailing Address - Phone:832-438-0330
Mailing Address - Fax:
Practice Address - Street 1:6302 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7859
Practice Address - Country:US
Practice Address - Phone:832-438-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061917363LP0808X
OR202205752NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL043103013Medicaid
MO2009039423Medicaid
IL043103013OtherBLUE CROSS BLUE SHIELD
IL043103013Medicaid
IL043103013OtherBLUE CROSS BLUE SHIELD