Healthcare Provider Details

I. General information

NPI: 1831623990
Provider Name (Legal Business Name): NICHOLAS ONYEAKAZI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD STE E201
LAS CRUCES NM
88011-4688
US

IV. Provider business mailing address

755 S TELSHOR BLVD STE E201
LAS CRUCES NM
88011-4688
US

V. Phone/Fax

Practice location:
  • Phone: 701-800-1332
  • Fax:
Mailing address:
  • Phone: 701-800-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR47976
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number87799
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number87799
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133513
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09859
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: