Healthcare Provider Details

I. General information

NPI: 1801897475
Provider Name (Legal Business Name): STELLA NGOZI NWANKWO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E CLARENDON DR
DALLAS TX
75203-2914
US

IV. Provider business mailing address

2855 KATE LN
GRAND PRAIRIE TX
75052-8540
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-4903
  • Fax: 214-941-4904
Mailing address:
  • Phone: 646-331-3444
  • Fax: 817-385-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL7079
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: