MEDICARE: FLORENCE IFEYINWA CHINWUBA FNP- BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP144948	TX

General Provider Information

NPI Number	:	1063044048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE IFEYINWA CHINWUBA FNP- BC

Provider Business Mailing Address
First Line	:	1452 JUNCTION RUN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4409
Country	:	US
Telephone Number	:	214-675-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 JUNCTION RUN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4409
Country	:	US
Telephone Number	:	214-675-9616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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Directions to “ FLORENCE IFEYINWA CHINWUBA FNP- BC” Practice Location

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