Itoro Cosmas Etim

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

1021444 Issued in TX

Practice address

13601 Preston Rd Ste 210W
Dallas, TX 75240-4986

Phone

(972) 702-0300

NPI assigned

Mar 9, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1053906230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13601 PRESTON RD STE 210W",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752404986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13601 PRESTON RD STE 210W",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752404986",
            "telephone_number": "972-702-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIM",
        "first_name": "ITORO",
        "middle_name": "COSMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TX",
            "license": "1021444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Marie Etheridge, NP
• Cecilia Grace Ethun
• Kristen Nardozzi Etibo
• Brooke Elisabeth Etie, LCSW
• Shamelya Marie Etier, C.M.A
• Yasser Etman, MD
• Kevin Etter
• Mark Raymond Ettinger, MD
• Stacy Gail Ettinger, CPNP
• Chinyere J Etufugh

• All providers in Dallas, TX
• Licensed Vocational Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.