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General NPI Number Information
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NPI Number | 1356217343
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Entity Type | Organization
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Legal Business Name | ALPHA AND OMEGA STAR LLC
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Dates
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Enumeration Date | 10/15/2025
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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 | 281-729-8173
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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 | 281-729-8173
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER - FAMILY
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Name | HENRIETTA A AGUWA
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Credential | NP
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Telephone | 215-967-4236
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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 |
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License Number State |
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