MEDICARE: ONYINYE MARYGRACE OBIORAH PMHNP-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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1041108	TX

General Provider Information

NPI Number	:	1912729435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONYINYE MARYGRACE OBIORAH PMHNP-BC

Provider Business Mailing Address
First Line	:	9550 SKILLMAN ST # 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-8261
Country	:	US
Telephone Number	:	469-588-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	9550 SKILLMAN ST # 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-8261
Country	:	US
Telephone Number	:	469-588-1502
Fax Number	:

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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Directions to “ ONYINYE MARYGRACE OBIORAH PMHNP-BC” Practice Location

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