Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP136284 | TX |
NPI | 1043717747 |
---|---|
Provider Name | Michael Owusu Agyemang |
First Address | Dallas, TX 75216-7167 |
Second Address | Grand Prairie, TX 75052-7280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 28/09/2021 |