Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 844501 | TX |
NPI | 1003467879 |
---|---|
Provider Name | Sunny Akwo Makolo |
First Address | Dallas, TX 75235-7793 |
Second Address | Dallas, TX 75235-7793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2019 |
Last Update Date | 24/09/2019 |