Healthcare Provider Details

I. General information

NPI: 1396307880
Provider Name (Legal Business Name): CHINEDU EUSTACE IGWEBUIKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 SKILLMAN ST APT 206
DALLAS TX
75231-2906
US

IV. Provider business mailing address

7920 SKILLMAN ST APT 206
DALLAS TX
75231-2906
US

V. Phone/Fax

Practice location:
  • Phone: 469-605-7944
  • Fax:
Mailing address:
  • Phone: 469-605-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number972345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: