MEDICARE: JUDITH DIANNE ONYANCHA

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	164W00000X	Licensed Practical Nurse	PN5212405	FL

General Provider Information

NPI Number	:	1437781341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH DIANNE ONYANCHA

Provider Business Mailing Address
First Line	:	7252 LUMBER PORT DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-0131
Country	:	US
Telephone Number	:	813-352-8011
Fax Number	:

Provider Business Practice Location Address
First Line	:	7252 LUMBER PORT DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-0131
Country	:	US
Telephone Number	:	813-352-8011
Fax Number	:

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

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	02/08/2020

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Directions to “ JUDITH DIANNE ONYANCHA ” Practice Location

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