Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | VA0101259717 | VA |
N | 208D00000X | General Practice Physician | 0101259717 | VA |
NPI | 1619391760 |
---|---|
Provider Name | Chinyere Mbagwu |
First Address | Lubbock, TX 79430-0002 |
Second Address | Lubbock, TX 79430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2014 |
Last Update Date | 13/06/2018 |