MEDICARE: JUSTINA NWEKE NP-C

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	F1106068	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8Y1128	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1164582714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINA NWEKE NP-C

Provider Business Mailing Address
First Line	:	2459 E HEBRON PKWY STE 130
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4477
Country	:	US
Telephone Number	:	972-239-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2459 E HEBRON PKWY STE 130
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4477
Country	:	US
Telephone Number	:	972-239-8131
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	02/03/2017

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