Healthcare Provider Details

I. General information

NPI: 1437979267
Provider Name (Legal Business Name): PATRICKHOLMES NNAMDI ONYEOGALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W WALNUT HILL LN APT 1329
IRVING TX
75038-5130
US

IV. Provider business mailing address

3025 W WALNUT HILL LN APT 1329
IRVING TX
75038-5130
US

V. Phone/Fax

Practice location:
  • Phone: 817-768-0249
  • Fax:
Mailing address:
  • Phone: 817-768-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9622139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: