Healthcare Provider Details

I. General information

NPI: 1780577452
Provider Name (Legal Business Name): ONYINYECHI MGBAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18383 PRESTON RD STE 202
DALLAS TX
75252-5487
US

IV. Provider business mailing address

18383 PRESTON RD STE 202
DALLAS TX
75252-5487
US

V. Phone/Fax

Practice location:
  • Phone: 404-852-3399
  • Fax:
Mailing address:
  • Phone: 404-852-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number235581
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number235581
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: