MEDICARE: GLORIA UCHEBUNMA NWEKE

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	1070155	TX

General Provider Information

NPI Number	:	1326066358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA UCHEBUNMA NWEKE

Provider Business Mailing Address
First Line	:	3435 HIGHLAND RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7165
Country	:	US
Telephone Number	:	972-686-4209
Fax Number	:	972-686-3825

Provider Business Practice Location Address
First Line	:	3435 HIGHLAND RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7165
Country	:	US
Telephone Number	:	972-686-4209
Fax Number	:	972-686-3825

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/01/2024

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