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General NPI Number Information
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NPI Number | 1063256741
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Entity Type | Individual
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Provider Name | HENRIETTA A AGUWA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 2356 CALENDAR CT
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-7626
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Country | US
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Telephone | 215-967-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 2356 CALENDAR CT
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-7626
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Country | US
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Telephone | 215-967-4236
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1169291
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 905033
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1169291
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License Number State | TX
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