Healthcare Provider Details

I. General information

NPI: 1285026963
Provider Name (Legal Business Name): IJEOMA NNAMANI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 WESTPARK WAY STE 123
EULESS TX
76040-3964
US

IV. Provider business mailing address

350 WESTPARK WAY STE 123
EULESS TX
76040-3964
US

V. Phone/Fax

Practice location:
  • Phone: 817-267-3065
  • Fax: 817-545-9097
Mailing address:
  • Phone: 817-267-3065
  • Fax: 817-545-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP1376
License Number StateTX

VIII. Authorized Official

Name: IJEOMA NNAMANI
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 214-513-2421