Healthcare Provider Details

I. General information

NPI: 1396116950
Provider Name (Legal Business Name): PATIENCE C ONUOHA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 1ST ST NW
BRITT IA
50423-1227
US

IV. Provider business mailing address

4319 S NATIONAL AVE # 302
SPRINGFIELD MO
65810-2607
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-04674
License Number StateIA

VIII. Authorized Official

Name: PATIENCE C ONUOHA
Title or Position: SOLE OWNER
Credential: D.O.
Phone: 973-789-1443