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General NPI Number Information
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NPI Number | 1023871761
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Entity Type | Individual
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Provider Name | ALLOYSIUS IGWEBUIKE
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Gender | Male
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 1320 NW SUMMERCREST BLVD APT 212
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City | BURLESON
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State | TX
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Zip | 76028-9434
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Country | US
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Telephone | 121-471-4054
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | BURLESON
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State | TX
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Zip | 76097-0112
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Country | US
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Telephone | 214-714-0544
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 231856
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License Number State | TX
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