Healthcare Provider Details

I. General information

NPI: 1891420824
Provider Name (Legal Business Name): CHIBUOGWU LILIAN KANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75080-1135
US

IV. Provider business mailing address

1301 W PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75080-1135
US

V. Phone/Fax

Practice location:
  • Phone: 855-247-8474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10210031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: