MEDICARE: CAROLYN OKONOFUA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP140241	TX

General Provider Information

NPI Number	:	1083266274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN OKONOFUA

Provider Business Mailing Address
First Line	:	3727 DILIDO RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5531
Country	:	US
Telephone Number	:	214-275-8898
Fax Number	:	214-275-9986

Provider Business Practice Location Address
First Line	:	3727 DILIDO RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5531
Country	:	US
Telephone Number	:	214-275-8898
Fax Number	:	214-275-9986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	03/02/2021

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Directions to “ CAROLYN OKONOFUA ” Practice Location

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