Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 771299 | TX |
NPI | 1003243379 |
---|---|
Provider Name | Ms. Olayemi Ononogbu |
First Address | Mesquite, TX 75149-8402 |
Second Address | Dallas, TX 75235-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2013 |
Last Update Date | 15/03/2017 |