Healthcare Provider Details

I. General information

NPI: 1396256590
Provider Name (Legal Business Name): DAVID ARUWA OKWATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 03/09/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W. HWY 29
BERTRAM TX
78605-5681
US

IV. Provider business mailing address

PO BOX 26531
AUSTIN TX
78755-0531
US

V. Phone/Fax

Practice location:
  • Phone: 512-300-7297
  • Fax:
Mailing address:
  • Phone: 512-300-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: