MEDICARE: GERTRUDE NWOKE

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	AP141116	TX

General Provider Information

NPI Number	:	1114488699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERTRUDE NWOKE

Provider Business Mailing Address
First Line	:	6181 BONNIE VIEW RD STE 160
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5149
Country	:	US
Telephone Number	:	214-374-0827
Fax Number	:	214-374-0927

Provider Business Practice Location Address
First Line	:	6181 BONNIE VIEW RD STE 160
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5149
Country	:	US
Telephone Number	:	214-374-0827
Fax Number	:	214-374-0927

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	10/10/2022

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Directions to “ GERTRUDE NWOKE ” Practice Location

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