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General NPI Number Information
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NPI Number | 1013340520
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Entity Type | Individual
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Provider Name | MODESTA OBIAGELI ONYIA FNP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 205 E UNIVERSITY AVE SUITE 157
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City | GEORGETOWN
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State | TX
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Zip | 78626-6814
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Country | US
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Telephone | 512-868-9078
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Fax | 512-819-0646
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Provider Business Mailing Address
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Address Line | 1913 MESA CT
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City | GARLAND
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State | TX
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Zip | 75040-8289
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Country | US
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Telephone | 214-629-9639
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Fax | 972-278-4606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 679518
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License Number State | TX
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